Tinnitus

What is tinnitus? Tinnitus refers to the hearing of noises that are not caused by an external source. Often heard has a ringing or buzzing sound, these may be heard temporarily or chronically. Often, these noises are accentuated when there is absolute silence. Tinnitus is not a condition in itself, but a symptom of an underlying condition. What are the symptoms of tinnitus? In addition to hearing the buzzing, ringing sounds, tinnitus can cause difficulty sleeping and concentrating. As a result, it can sometimes put a strain on someone’s psychological well-being and personal relationships, particularly if it is chronic. What causes tinnitus? Tinnitus is not a disease, but a symptom of other ear pathologies, such as hearing loss. Therefore, the causes that can trigger it are multiple. Common causes include: Hearing loss Exposure to loud noises Blockages (from a build-up of earwax) Meniere’s disease TMJ disorders Head or neck injuries Certain medications (e.g. antibiotics, aspirin and certain antidepressants) High blood pressure and circulatory problems Can tinnitus be prevented? To prevent tinnitus, it is best to keep the ear clean and free of wax. It is also important to avoid caffeine, smoking, alcohol and excessive salt intake. It is also important to avoid noisy environments. People with cardiovascular problems are at a higher risk of developing tinnitus, so ensuring you maintain a healthy blood pressure and eat a healthy diet are important. What is the treatment for tinnitus? Treatment will depend on the underlying cause and treating this is the first step. Often this will involve either removing excessive earwax, changing your medications for other conditions or treating a blood vessel problem. If these do not help, then there are other therapies that can help you overcome the irritation caused by the tinnitus. For example, noise suppression training involves using special devices to suppress noise (e.g. white noise machines, tinnitus retraining devices or masking devices). In addition, managing stress, and removing irritants (e.g. alcohol, caffeine and cigarettes) can help too. ...

Vertigo

What is vertigo? Vertigo is not actually a condition in itself, but is a symptom. It describes the feeling that everything around you is spinning, or that you are spinning yourself. In most cases vertigo gets better by itself, but if it happens repeatedly or keeps affecting you, it should be investigated. ‘Attacks’ of vertigo can last for just a few seconds, but they can also last longer, even for days or months in extreme cases. What causes vertigo? Vertigo is generally caused by problems with the inner ear, as the inner ear affects balance, causing the sensation of vertigo. Although sometimes the specific cause is unknown, some common problems with the inner ear causing vertigo include: Labyrinthitis (an infection of the inner ear) Ménière’s disease (a condition affecting the inner ear) Vestibular neuronitis (inflammation of the inner ear) Certain head movements, certain medications, and migraines can also cause vertigo. How is vertigo treated? Vertigo generally gets better on its own. You can manage vertigo attacks using some of the following measures: Lying still in a quiet, dark room Moving slowly while you go about your activities Trying to relax (stress and anxiety make vertigo worse) Getting up slowly from a lying position (e.g when waking up) Sitting down immediately if you’re feeling dizzy Not bending over when dropping something and picking it up. It’s better to squat and pick objects up this way Not stretching your neck or making sudden head movements If your vertigo keeps coming back, you should make an appointment with your doctor, who may refer you to a specialist to try and determine the cause. If the vertigo is caused by an infection, then antibiotics or other medication may be prescribed to clear up the infection. Your doctor may give you exercises to do when you experience vertigo to lessen symptoms. If vertigo is experienced along with hearing loss, double vision, loss of vision, difficulty when speaking, or limb weakness/numbness, you should visit A&E. Which specialist treats vertigo? Generally vertigo clears up on its own, but if you are having repeated attacks, your GP may refer you to an ENT doctor (otolaryngologist). ...

Acoustic neuroma

What is acoustic neuroma? An acoustic neuroma is a benign tumour which grows on the vestibular nerve, the nerve which connects your inner ear to your brain. In some cases, the tumour can grow rapidly and begin to put pressure on the brain, whereas in other cases the tumour can grow very slowly or not at all. What are the symptoms of acoustic neuroma? Symptoms arise from the pressure that the tumour puts on the nerves responsible for your balancing and hearing. Therefore the most common symptoms include: vertigo tinnitus (ringing in the affected ear) gradual hearing loss Other, less common symptoms may also occur, such as: dizziness difficulty in understanding speech numbness or pain in the face or ear loss of balance weakness in the face How is acoustic neuroma diagnosed? Acoustic neuroma is usually difficult to diagnose because the symptoms are subtle and can develop very gradually. The main methods of diagnosis are hearing tests and imaging, such as a head CT scan or MRI scan. If you already have a diagnosis of neurofibromatosis type 2, however, then you are likely to receive head scans on a regular basis. What are the causes of acoustic neuroma? The causes of acoustic neuroma are generally unknown. If it occurs in both ears (bilateral vestibular schwannomas), the cause is usually neurofibromatosis type 2, a hereditary disease. What is the treatment for acoustic neuroma? If the tumour is growing slowly, surgeons are likely to adopt a “wait and see” approach, with regular scans and hearing tests to assess the rate of growth. If treatment is required, the main options are: radiotherapy – this involves delivering a precisely targeted dose of radiation to the tumour to destroy it without damaging the surround tissue. If, however, the radiation damages the vestibular nerve, risks can include hearing loss, tinnitus, balance problems and facial weakness. surgery – if the tumour is large or growing quickly, surgery may be the recommended option. This is performed under general anaesthesia and involves attempting to remove the whole tumour. As with radiotherapy, hearing loss and facial weakness are risks if the vestibular nerve is damaged during the procedure. ...

Adenoids

What are adenoids? Adenoids are tonsil-like glands located at the back of the nose, above the roof of the mouth, at the intersection of the nostrils, throat and the eustachian tubes. During childhood, they form part of the body's defence system against infection. Their main function is to capture substances that could be harmful to the body (bacteria, viruses or dust) as they are breathed in, before they reach the lungs. Once captured, they process these substances and activate an immune response. Adenoids increase in size from birth, until the child is around 4 years old, and then shrink until they have almost disappeared in adulthood. What conditions can affect the adenoids Adenoids can become enlarged or swollen, usually due to infections or allergies. This is common, and is often accompanied by swollen tonsils. The adenoids may recover on their own and in most cases, they aren’t serious enough to impact the child’s day-to-day life. However, swollen or enlarged adenoids can sometimes cause problems, including: Blocked or runny nose Difficulty breathing Difficulty sleeping, including snoring and sleep apnoea Middle ear infections Glue ear Recurrent or persistent sinusitis A persistent blocked nose and the associated difficulty breathing through it leads to the child breathing through the mouth, which can cause a dry throat and, in turn, problems such as a sore throat, trouble swallowing, bad breath, and voice alterations. Medical tests for enlarged adenoids Adenoids cannot be seen through the mouth like the tonsils. The specialist will need to perform a physical examination of the nose, throat, and ears to assess whether they have increased in size. A lateral x-ray of the pharynx may also be performed to see the size. In severe cases where there is associated sleep apnoea, a sleep apnoea study should be performed to assess the intensity of the episodes. What causes adenoid problems? Enlarged adenoids usually occur due to bacterial or viral infections. The adenoid tissue may swell temporarily as it fights an infection in the airway, and may recover. The adenoids themselves can also become infected, and repeated infections of the respiratory tract, such as colds or flu can lead to persistent swelling. Some adenoid problems may be caused by the streptococcus virus or the Epstein-Barr virus, among others. Patients with enlarged adenoids are also at increased risk of tonsillitis, and may experience headaches and sore throats more often. Treatments for enlarged adenoids The first thing the specialist will do is prescribe antibiotics to combat the infection in the tonsils, adenoids, and sinuses. This will lower mucus production and clear the nostrils, but not all the inflammation. If breathing problems and difficulty sleeping are impacting the child’s life, the doctor will probably recommend surgical removal of the adenoid glands (adenoidectomy). If the child also frequently suffers from tonsillitis, the tonsils will likely be removed at the same time (tonsillectomy), which reduces the risk of complications. The operation is performed under general anaesthetic and consists of scraping the adenoids away with an instrument known as a curette or burning them away using heat from a high-frequency electrical current generated by a special diathermy instrument. The procedure is relatively quick. The child will be kept under observation for a few hours (occasionally overnight if the procedure was performed late in the day), and when the doctor is satisfied that they are recovering normally, they will be able to go home, usually in the same day. Which specialist treats adenoid problems? Any problems with the adenoids are treated by a paediatric otolaryngologist. ...

Aphonia (loss of voice)

The hoarseness is the loss of voice. Usually caused by an inflammation of the larynx or trauma. Causes of hoarseness: Respiratory diseases Speak very loudly, shouting, etc. Abuse snuff, alcohol, ... Causes nerve. Excessive cold; (Drinking very cold fluids, ice cream ...) ...

Audiometry

What is audiometry? An audiometry exam evaluates your hearing function in terms of tone, balance and sound intensity. It focuses on the functioning of the inner ear. The human ear can perceive sounds with tones that range between 20 and 20,000 Hertz. The human ear can hear sounds with intensity ranging from 20 decibels upwards. What does audiometry involve? An audiometry exam involves several different tests. A pure tone audiometry test measures softest, quietest sounds you can hear at different pitches. This uses an audiometer which is a special machine that plays sounds via headphones. You will indicate to the clinician which sounds you can hear. A speech audiometry exam tests how well you can hear speech at different tones. The exam is divided into tonal and verbal audiometry. In tonal audiometry, the airway and the bony route are evaluated, which in both cases involves the exploration of the two ears separately, with the patient inside a soundproof and hermetically sealed cabin. In air audiometry, the individual must put on headphones and then the specialist plays a series of sounds from higher to lower volume until they are inaudible. The last perceived sound determines the auditory threshold, that is, to what intensity the patient can hear at a certain frequency. In the inspection of the bone path, a vibrator is placed behind the patient's ear, in the mastoid, where it receives the sound. Verbal audiometry is also performed with the patient in a booth and with headphones, but instead of sound, words are issued at different volumes that must be repeated exactly. A word-recognition test is also performed which measures the patient’s ability to discriminate between speech and background noise. Tympanometry testing can uncover any problems with wax or fluid build-up, ear drum damage, ossicle bone damage or tumours in the middle ear. An acoustic reflex test is used to locate where the hearing impairment may be located. Why is audiometry done? Audiometry can detect hearing loss and is performed when a patient has trouble hearing or as part of a routine screening. An audiometry exam can determine whether someone is suffering from sensorineural hearing loss (nerve or cochlea damage) or conductive hearing loss (ear drum or ossicle bone damage). Hearing loss commonly results from: Chronic ear infections Birth defects Damage to the ear drum or inner ear Exposure to loud noises on a regular basis Inner ear diseases Inherited conditions How to prepare for audiometry: No special preparation is needed to perform this test. How does it feel during the audiometry exam? During the test, the patient does not feel any discomfort. The duration of the exam varies depending on whether it is an initial evaluation, which can last between 5 to 10 minutes; or if it is a detailed evaluation that can last up to almost an hour. Risks of audiometry: Audiometry is non-invasive and carries no risks. What do abnormal results mean? The results are shown on a graph (audiogram). The results are reviewed by the specialist and if they confirm hearing loss, management and treatment techniques will be discussed. These could include wearing a hearing aid. ...

Cholesteatoma

What is a cholesteatoma? A cholesteatoma is a rare abnormal growth of skin in the middle ear behind the eardrum that is formed of skin cells. Over time it can grow and destroy middle ear bones or nearby ear structures. If left untreated, a cholesteatoma can lead to further complications, including ear infections, hearing loss, tinnitus (sounds which come from inside the body rather than external noise), and vertigo (dizziness or the sensation things are spinning). A cholesteatoma can also cause damage to the facial nerve. A cholesteatoma can, on very rare occasions, spread to the brain and inner ear, which can lead to meningitis, or a brain abscess. However, it is important to note that this is exceedingly rare. What are the symptoms of a cholesteatoma? A cholesteatoma generally only affects one ear, and some common symptoms include: Hearing loss (which is usually gradual) Loss of balance/dizziness A watery discharge from the ear, which can smell bad Discomfort in the affected ear Some of the symptoms are similar to those of an ear infection, so it is best to visit your GP who can check the symptoms and refer to a specialist if necessary. What are the causes of a cholesteatoma? Congenital cholesteatomas are rare, but they can occur. Cholesteatomas can also form if part of the eardrum collapses, which creates a ‘pocket’ in the ear where dead skin cells collect. This can also occur if the eardrum is damaged in any way, such as during surgery, or after an injury or infection. What is the treatment for a cholesteatoma? A cholesteatoma generally has to be removed through surgery, which is usually successful. However, in some cases, the cholesteatoma may reappear, meaning further surgery may be needed. There are rarely complications following cholesteatoma surgery, but your surgeon will explain the risks the procedure carries beforehand. ...

Chronic cough

What is a chronic cough? Most coughs cause discomfort, but they usually serve a use – when we cough, we expel germs, mucus and foreign material from our lungs. Most only last a short time. However, sometimes they linger for weeks or even months. A chronic cough is defined as one that lasts for eight weeks or longer in adults or over four weeks in children. They can potentially be very disruptive to the patient’s life, interrupting sleep and leading to fatigue, and in severe cases, they can cause vomiting, light-headedness, and even rib fractures. Symptoms of chronic cough: The cough itself is a symptom of an underlying condition, but it may be accompanied by other symptoms, some of which may be a result of the coughing. Stuffy nose Runny nose Post-nasal drip Sore throat Hoarseness Wheezing/shortness of breath Heartburn Sour taste in the mouth Coughing up blood What are the causes of chronic cough? There are several things that can cause a chronic cough: Asthma Chronic bronchitis Infections, e.g. pneumonia Smoking Postnasal drip Gastroesophageal reflux disease (GERD) Certain medications, e.g. ACE inhibitors for high blood pressure In rarer cases the following can also be responsible: Bronchiectasis (damaged airways) Cystic fibrosis Lung cancer Aspiration Sarcoidosis Bronchiolitis Whooping cough When to see a doctor When a cough lasts for more than a few weeks, it is worth having it checked out by a doctor. If you cough up blood, or experience weight loss, fever, or trouble sleeping, you should consult your GP or a specialist. Treatments for chronic cough Treatment for chronic cough depends largely on the cause, as treatment tends to be targeted at the underlying illness, rather than the symptom. For example, antibiotics may be prescribed to treat a bacterial infection, while asthma could be treated with steroids and/or bronchodilators. If you have a chronic cough, consult a doctor and follow their advice. Which type of specialist treats chronic cough? Specialists in pulmonary and respiratory medicine and otolaryngologists may both treat chronic cough, and other specialties may be involved, depending on the underlying cause. ...

Congenital malformations

What are congenital malformations? Congenital malformations are defects or abnormalities in the baby's body that develop during pregnancy. There are more than 4000 types of congenital malformations, and they are categorised into two main groups: Structural congenital malformations: Those in which the baby is born without a part of the body or they have a malformation in that part. Within this group, the most frequent are cardiac congenital anomalies, as well as cleft palate, congenital hip dysplasia, spina bifida or clubfoot. Functional congenital malformations: Refers to when there is a problem in the chemical composition of the body, as happens with those that affect the nervous, metabolic or immune system. The most well-known are Down’s syndrome, deafness, blindness, congenital hypothyroidism or Tay-Sachs disease. Prognosis: According to figures from the World Health Organization, every year 303,000 new-borns die during the first 4 weeks of life, due to congenital malformations. However, many of these diseases can be avoided if they are detected early during pregnancy. There are many degrees of severity in congenital malformations, with some not requiring treatment, whereas others may need treatment and monitoring for a few years or for life, or even require emergency surgery. The reality is that congenital malformations represent an important cause of infant mortality, disabilities and chronic diseases. Due to advances in medicine, congenital malformations occur in very few cases. On the other hand, since many of them are rare or uncommon diseases, they represent a major challenge for thousands of families, who are far more helpless when facing an unknown disease. Symptoms of congenital malformations: When a baby is in the womb and presents anomalies it does not cause symptoms in the mother, so the only way to detect them is to carry out a correct pregnancy follow-up and genetic and prenatal studies. On the other hand, the symptoms that cause congenital anomalies in the new-born are very diverse depending on the malformation and the degree that it presents. Some malformations are unnoticeable or allow a totally independent life, whilst others are disabled or require lifelong treatment. Medical tests for congenital malformations: The majority of diagnostic tests for congenital malformations are usually performed during pregnancy in the check-ups that the expectant mother must perform with the specialist. An ultrasound allows the gynaecologist to check the development of the foetus, which can detect a large number of congenital malformations: for example, it can detect Down’s syndrome during the first trimester of pregnancy or serious foetal anomalies up until the second trimester. Amniocentesis is another of the key tests that allows the detection of congenital malformations, such as neural tube defects or chromosomal abnormalities during the first two trimesters of pregnancy. On the other hand, before a pregnancy it is also recommended that the couple should perform genetic testing to know the risk they have of having a baby with congenital anomalies, as some are hereditary. What are the causes of congenital malformations? Most of these malformations are of unknown origin, but several factors have been detected that may be related to the development of several of them: Genetics of the parents Abuse of certain types of drugs The age of the mother Illnesses that the mother suffers during pregnancy Diet and health care done during pregnancy Can congenital malformations be prevented? Specialists in gynaecology, obstetrics and healthcare organisations such as the World Health Organization recommend a series of primary prevention measures for congenital malformations: Take care of the woman's diet during pregnancy, with the necessary contribution of vitamins and minerals such as folic acid. Avoid the consumption of toxic or harmful substances such as tobacco, alcohol and recreational drugs. Control diabetes. Avoid exposing yourself to toxic or dangerous substances, such as pesticides. Avoid exposure to radiation and medication intake as much as possible. Improve vaccination, especially against the rubella virus. Treatments for congenital malformations: Many congenital malformations can be corrected or improved with paediatric surgery, even during pregnancy. In other cases, new-borns may need pharmacological treatment from birth or even undergo emergency operations to save their lives. The treatment that each patient will need will vary depending on their malformation or congenital pathology, as well as their development. What specialist treats congenital malformations? Gynaecologists and obstetricians who carries out pregnancy check-ups are usually the first to detect any congenital malformations. A paediatric surgeon can intervene in the treatment of some malformations, just as the paediatrician will be the specialist in charge of monitoring and assessing the baby after birth. Other specialists, such as speech therapists or psychologists may also be involved in the treatment of congenital malformations. ...

Deafness

What is deafness? Deafness, also known as hearing loss, describes difficulty hearing or the total inability to hear. Deafness can be partial or complete and can occur gradually, with age or it can happen suddenly. Some people are born with deafness. What are the symptoms of deafness? Particularly if hearing loss is happening gradually, noticing it can be difficult. However, the following are common signs that you may be going deaf: Asking people to repeat themselves Needing to turn the television up loud Difficulty hearing people, especially in loud places Muffling of speech Withdrawing from taking part in conversations What causes deafness? The causes of deafness can be congenital or acquired. Congenital causes present at birth or soon after and can be hereditary or non-hereditary, and are due to complications during pregnancy or childbirth. As for the acquired causes, these can occur at any age due to: Infection or growths (tumours) Chronic ear infection Exposure to excessive noise Ageing Build-up of earwax Ruptured ear drum Can deafness be prevented? There are certain risk factors that can damage the ear or cause deafness, so prevention can be sought by: Avoiding loud noises (e.g. music concerts for long periods of time, listening to music too loudly) Vaccinating children against measles and meningitis Having hearing tests for children Avoiding certain medications, if possible Taking care if your work involves loud noises, wearing ear protectors What is the treatment for deafness? Sometimes, hearing loss will get better on its own, for example, if earwax is removed or treated with eardrops. However, other forms of deafness can be permanent. In such cases, treatment will aim to improve what hearing you have left. This can be done with hearing aids, cochlear implants, or by teaching lip reading or sign language. ...

Disorders of nasal breathing

What are disorders of nasal breathing? Nasal breathing disorders are relatively common and mainly cause difficulties in breathing properly through the nose. The most common nasal breathing disorders include: Sinusitis – swelling of the sinuses due to infection. Deviated septum – the nasal septum (the bone and cartilage that divides the nasal cavity is crooked, which makes breathing difficult. Nose / sinus trauma due to injury – for example, a broken nose that has not healed properly can cause chronic nasal breathing issues. Nasal Valve Collapse (NVC) – when nasal tissues are not formed correctly or are weak, creating difficulty breathing through the nose. What are the symptoms? The symptoms vary for each disorder. Sinusitis – Pain and tenderness around the cheeks, eyes and forehead Blocked nose Green or yellow mucus Headache High temperature Bad breath Reduced sense of smell Deviated septum – Facial pain Nosebleeds Loud breathing Snoring Headache Runny nose Nose / sinus trauma due to injury Congestion and difficulty breathing through the nose Nasal Valve Collapse (NVC) Nasal obstruction Nosebleeds Congestion and difficulty breathing through the nose What causes nasal breathing disorders? Sinusitis is most often caused by an infection. It can also be caused by a common cold, allergic rhinitis (which causes the lining of the nose to swell), nasal polyps on the lining of the nose or a deviated septum. Sinusitis is very common and it is very common to have sinusitis following a cold of the flu. A deviated septum is usually something some people are born with, but it can also be caused by trauma or injury to the nose. Nasal Valve Collapse can be caused by: Rhinoplasty (nose job) – plastic surgery to the nose, for example, removing the nose hump can cause NVC. Deviated septum – a very common cause of NVC which can result from nasal injury or surgery. Trauma or nose surgery – due to inflammation, swelling or the formation of scar tissue. Inherited anatomical characteristics – for example, noses that are over-projecting, have narrow nostrils and a wide columella (the exterior part of the nose that separates each nostril) can result in NVC naturally. What is the treatment? Sinusitis - Treating simple sinusitis does not usually involve seeing a doctor, and doing the following will usually clear it up: Plenty of rest Keeping hydrated Painkillers Steaming your face over a bowl of hot water Using an over-the-counter decongestant nasal spray If sinusitis persists, a doctor may prescribe antibiotics, for a course of usually 10 to 14 days. For those suffering from chronic sinusitus, a warm compress to the nose, saline nose drops and prescribed steroids can help. Deviated septum – In some cases, the symptoms caused by a deviated septum can be relieved by medication. However, if this is not the case, then a surgical procedure called a septoplasty might be recommended. This procedure restores the crooked septum to improve nasal breathing. A septoplasty involves the removal of excess bone and cartilage and is sometimes performed under general anaesthetic. This procedure is often combined with a rhinoplasty to imporve the appearance of the nose. Nasal Valve Collapse – There are two key approaches to treating NVC: Surgery (rhinoplasty) is carried out to repair the collapsed nasal valve. Sometimes a special implant, made of titanium is required to hold the nasal valve open. Nasal valve dilator – for those who do not wish to undergo surgery, using a nasal valve dilator to manually widen the nasal valve can provide nasal breathing relief. These can either be in the form of stick-on strips that you wear across the bridge of your nose. They can also be special silicon inserts that are worn internally. ...

Dysphagia

What is dysphagia? Dysphagia is the medical term for a person who has swallowing difficulties. Some people cannot swallow certain foods or liquids, whilst others have trouble swallowing at all. The condition is usually caused by nerve or muscle problems, and is more common in the older generation and babies. There are three different types: Oral dysphagia – which occurs in the mouth and is sometimes caused by tongue weakness, especially following a stroke. Pharyngeal dysphagia – is a problem in the throat that is normally caused by neurological problems, such as Parkinson’s disease. Oesophageal dysphagia – is in the oesophagus and is usually because of a blockage or irritation and requires surgery. What are the symptoms of dysphagia? The symptoms of dysphagia may include: pain or discomfort when swallowing expulsion of food or liquid from the mouth involuntary drooling residues of food in the mouth or tongue frequent clearing of the throat swallowing in very small pieces the feeling of a blockage in the throat frequent bronchitis and pneumonia What are the causes of dysphagia? Normally, dysphagia occurs secondary to another disease or injury, such as: A condition to affect the nervous system – stroke, head injury, multiple sclerosis, dementia Cancer Gastro-oesophageal reflux disease (GORD) Risk factors for dysphagia include ageing as this is due to general wear and tear on the body over time. Neurological conditions can make dysphagia more likely. How is dysphagia diagnosed? A speech-language specialist will try to determine the problem. The patient will take a: Swallow study – where the specialist tests different consistencies of food and liquid. Barium swallow test – after swallowing a barium-containing liquid, the barium shows up in an X-ray to help the doctor see what is happening in the muscles of the oesophagus. Endoscopy – a camera is used to look down the oesophagus. How is dysphagia treated? The treatment depends on the type of dysphagia that the patient has. Oral dysphagia is a neurological problem and treatment can be a challenge. Swallowing therapy can be done with a speech and language therapist. The patient may also need to be fed through a feeding tube. A nasal tube or PEG (percutaneous endoscopic gastrostomy) is used to feed a patient who is at risk of pneumonia, malnutrition or dehydration. Oesophageal dysphagia usually requires surgery. If the oesophagus needs to be widened then a small balloon is inserted and then removed. In cases of stiff muscle, Botox® is used to paralyse it in order to reduce constriction. If cancer is the cause of dysphagia, the patient is referred to a specialist for treatment to have a tumour removed surgically. ...

Dysphonia

Dysphonia is a disorder characterised by an alteration of the timbre of the voice (difficulty in speaking) which can be due to various organic or functional causes of the larynx and vocal cords. When it occurs in children, it can come from neurological disorders, malformations of the larynx, laryngeal papillomatosis caused by viral infections, or from the voice being overly strained. The latter is the most common cause of dysphonia in adults, and that an untreated hyperfunction voice can produce other pathologies such as nodules or polyps on the vocal cords. In addition, other factors that can trigger dysphonia: gastro reflux, smoking, infections such as laryngitis or tuberculosis, neurological disorders or tumours of the larynx. ...

Eagle syndrome

What is Eagle syndrome? Eagle syndrome, also known as styloid syndrome, stylohyoid syndrome, or styloid-carotid artery syndrome, is a rare disorder of the stylohyoid ligaments that connect the skull with the hyoid bone of the neck. The condition may occur as a result of an elongated or misshaped styloid process (a slim pointed bone located just below the ear). What are the symptoms? Eagle syndrome is characterised by recurrent pain which occurs in the middle area of the throat, otherwise known as the oropharynx. Recurrent pain can also occur in the face, and the throat pain may feel worse or radiate further towards the ear as you turn your head. Other symptoms of Eagle syndrome include: Tinnitus (ringing or buzzing in the ears) Problems swallowing The feeling something is stuck in your throat Causes of Eagle syndrome There is a small, pointy bone just below the ear called the styloid process. It is located 5 cm deep and connects the skull with the neck through the stylohyoid ligament. The causes of Eagle syndrome are not completely understood, but the syndrome may also be related to the calcification or fibrosis of the styloid ligament, which usually occurs in middle-aged adults, although it can also affect young people, presenting a higher incidence in women than in men. There may also be a genetic factor in the appearance of Eagle syndrome. Treatment of Eagle Syndrome The treatment for Eagle syndrome varies depending on the symptoms. Depending on the case, it may be medically managed by pain or anti-inflammatory medications, or even corticosteroid injections. In more severe cases, the styloid process is shortened through surgery. Techniques are frequently improving and developing, and more recently this surgery has been carried out using minimally-invasive techniques, such as an endoscope-assisted styloidectomy. ...

Ear neuro-surgery

What is otoneurosurgery? Otoneurosurgery is the branch of neurology dedicated to surgically treating all pathologies encompassed within it, including diseases affecting the inner ear and a number of nerves that run through or near the ear (facial, auditory, vestibular and lower cranial pairs, hypoglossal, vagal and spinal). Treatment includes acoustic neuroma surgery, posterior fossa surgery and surgery of the lateral region of the skull base, among others. The otorhinolaryngologist is the specialist who will perform the surgery, with microscopic practice and the precision required for working in narrow areas. Why is otoneurosurgery performed? Otoneurosurgery is performed for the early diagnosis of peripheral and central lesions, or a pathology of the lateral base of the skull, and is also used to treat these problems. The diagnosis of acoustic neuroma is based on a high index of suspicion of impaired hearing and vestibular functions. It is the otorhinolaryngologist who, using various otoneurosurgical techniques and approaches, will have knowledge about the auditory and vestibular pathways, organ preservation and rehabilitation of hearing with cochlear implants, and assessment of balance using dynamic posturography. Neurosurgery also encompasses knowledge of the facial nerve and the ability to manage the nerve and rehabilitate associated conditions. What does otoneurosurgery involve? Otoneurosurgery involves using different surgical approaches to correctly assess the person’s condition. These include presigmoid approaches, such as retrolabyrinthine, translabyrinthine, transcochlear and transotic, or burr holes made in the middle cranial fossa. These are common practices in the otorhinolaryngologist’s work. In addition, infratemporal approaches and the combination of many of these allow access to more complex local injuries. Traditional neurosurgical approaches, such as the retrosigmoid approach and the extreme lateral approach also come under otorhinolaryngology. The specialist will usually apply a local anaesthetic before making the necessary incisions and performing the procedures, and will recommend the most appropriate approach in each case. Preparing for otoneurosurgery: Prior to otoneurosurgery surgery, the otorhinolaryngologist will check to make sure that you have no ear infections. To do this, they will perform several tests, including an ear examination and hearing test. In some cases, a CT scan of the head will also be required. It is also important that you ask the doctor what medications you may or may not take. You may need to stop taking some medications (aspirin, anti-inflammatory drugs, or anticoagulants) a week prior to the procedure. Post-surgery care: You will have to follow some guidelines to ensure proper recovery after the procedure. The otorhinolaryngologist will advise you to avoid any risks of knocks to the ear, prevent water from entering the ear, and to avoid flying, swimming or diving, as well as excess strain. ...

Ear wax plugs

What are wax plugs? Earwax build-up, also known as earwax plugs, are the accumulation of earwax in the ear, which usually result in hearing loss. In the external auditory canal there are a series of glands and follicles that create wax, which accumulates in the outer ear, where it is removed by washing the ears. However, often this earwax is not removed properly and forms plugs in the ear canal, which are the most common cause of hearing loss. Symptoms of earwax build-up Signs that you have a build-up of wax in your ears include: Sensation of blockage in the ear Earache Tinnitus (noises in the ear that do not come from outside) Hearing loss or partial hearing loss In severe cases, it can cause fever and discharge from the ear. What causes a build-up of earwax? Earwax exists to protect the ear from bacteria, dust, water and external agents in general. However, some people produce more earwax in their ears than is removed, leading to wax building up and hardening in the ear canal. Also, during washing, the wax can accidentally be pushed deeper into the ear, blocking it. Can wax plugs be prevented? Good hygiene of the ears is fundamental to avoid the accumulation of wax that causes the plugs. While it is true that some people’s ears produce more wax than others, more necessary will be a routine cleaning of the ears to remove excess wax. Treatment of build-ups of earwax In some cases the build-ups of wax may disappear by softening the wax, for which water or baby oil is usually used. In most cases, the wax plugs will require a professional wash with a syringe that will dissolve the wax with water under pressure. It is recommended to leave this treatment in the hands of an otolaryngologist (ENT specialist) to avoid damage to the eardrum. The otolaryngologist may also act on the earwax plug by other methods, such as suctioning the ear canal or using a curette. ...

Endoscopic sinus surgery

What is endoscopic sinus surgery? Sinus surgery was typically performed in the past using external incisions, which caused discomfort and a significant amount of pain to the patient. Nowadays, however, endoscopic sinus surgery tends to be the standard surgery performed for conditions such as chronic sinusitis. In endoscopic surgery, a small telescope with a camera on the end is inserted up the nose to view the area to be operated on. This surgery is used to treat injuries or abnormalities that alter normal nose function or surrounding structures. Surgery is done under general anaesthetic. Why would you do it? This surgery is done when there is chronic nasal and sinus inflammation, especially in chronic sinusitis, nasal polyps, or acute recurrent sinusitis that has not responded well to medical treatment. The treatment aims to restore normal nasal sinus function through a minimally invasive surgical procedure. This surgery is also used for septoplasty, turbinate surgery, closure of cerebrospinal fluid fistulas, and orbital decompression among others. What does it involve? A nasal decongestant should be used before dissecting the nose. A thin optic fibre is inserted in the nasal fossa to be able to view the sinus openings. With the right tools, the abnormal or obstructive tissue is resected. After surgery any bleeding points will be checked on, and in some cases nasal packing will be done to prevent haemorrhages, or silicone sheets will be placed to prevent the walls sticking to each other and forming anomalous scars. Surgery tends to last between 1 and 3 hours depending on the complexity of the case. The nasal cavities are blocked with coagulant foam and special sponges that dissolve, or plugs that can be taken out easily. How to prepare for it Before surgery a sinus CT scan will be done to be able to plan the best form of treatment. Preoperative tests will also be carried out, as the surgery is done under general anaesthetic. The patient is normally in for a short stay surgery, they are only there one night. The patient should fast for 6 to 8 hours before the procedure. Post-operative care The nose is usually blocked, so the patient can’t breathe through it. Bleeding may occur, so a gauze is placed under the nose, although it’s not always needed. For the first 3-4 days, the patient is advised not to; smoke, drink alcohol, or physically exert themselves. Patients are also told to rest at home, avoid blowing their nose, and sit in a position that reduces blood flow to the head, head congestion, and bleeding. Patients should follow a soft food diet and drink plenty of fluids for throat dryness due to nasal packing. It is not a painful procedure, but it can cause discomfort. Anti-inflammatory medication is generally prescribed. Antibiotics may also be prescribed to prevent an infection of the retained mucus. ...

Epistaxis

Epistaxis is a nosebleed originating from the nostrils. It can be caused by trauma, irritation or dryness of the lining of the nose, allergic rhinitis, colds or sinusitis. Other causes include nasal obstruction such as a deviated septum or foreign objects in the nose. In most cases it stems from the septum, which is the vertical cartilage that separates the nasal chambers and is covered by fragile blood vessels, which may break. A nosebleed usually stops by itself but any epistaxis requires medical help if it persists after 15 or 20 minutes, if nosebleeds are frequent, if the blood drains into the throat or neck or head injury is suspected. The best way to stop the bleeding is to sit leaning forward pinching the nose above the nostrils with the fingers and breathing through the mouth....

Facial nerve

What is the facial nerve? The facial nerve controls the muscles on the sides of the face, allowing us to smile, wink, cry, frown and make many other facial expressions. The facial nerve also helps us to control our facial movements when eating, drinking and speaking. There are two facial nerves – one on each side of the face which travels around the middle ear, exiting at the skull base and branching from the parotid gland. These branches allow motor function for all of the different facial muscles. What are some common conditions that affect the facial nerve? Damage to the facial nerve can result from: Trauma or injury (e.g. fractures, facial or ear injuries or surgical trauma) Skull base tumours Infection (e.g. Lyme disease and Ramsay Hunt syndrome) Toxins (alcoholism) Stroke and other neurological conditions Bell’s palsy (inflammation of the facial nerve) Trigeminal neuralgia What are the symptoms of conditions involving the facial nerve? Facial nerve disorders can result in the following symptoms: Drooping of the face Facial paralysis Weakened facial muscles Facial twitches Excessive salivation Dry eyes Changes in taste Symptoms will depend on the severity of damage caused to the facial nerve. How can the causes of facial nerve disorders be diagnosed? If a patient is experiencing symptoms of facial nerve damage, tests will be run to determine the underlying cause, so that the correct treatment can be given. The following tests may be used: Balance test Hearing test (to check the health of the auditory nerve) Taste test Salivation test Scans (CT, ultrasound, MRI) Electrical nerve stimulation tests How can facial nerve problems be treated? Depending on the cause, the following are potential treatments for the symptoms of facial nerve disorders: Artificial tears to keep the eyes moist Nerve repair or grafts Muscle transfers Eyelid procedures to reposition the eyelids Removing tumours that may be causing the nerve symptoms ...

Facial paralysis

What is facial paralysis? Facial paralysis is a condition that causes partial or total motor paralysis of the facial nerve and, therefore, of the facial musculature. What are the symptoms of facial paralysis? The symptoms of facial paralysis include being unable to perform certain movements such as smiling, opening and closing the eye completely or raising the eyebrow. What causes facial paralysis? Facial paralysis can be caused by various factors, including tumours, trauma, acute and chronic ear infections and congenital disorders (Moebius syndrome). However, its causes are mostly unknown, and in this case it is known as Bell's palsy or peripheral facial paralysis. How is facial paralysis treated? Normally steroids are given to slow down the progressive deterioration of the nerve and massages are performed on the facial muscles. In the more severe cases, specific surgical treatments are also performed, using both static and dynamic techniques to restore the movement and functionality of the muscles. Treatment for Bell's palsy, or peripheral facial paralysis, should be started immediately after onset for a faster and more effective recovery. Are there any complications during recovery? Recovery from facial paralysis is sometimes incomplete because the nerve is damaged and unable to function normally. Complications may occur, such as hemifacial spasm (where some of the muscles are permanently contracted) or synkinesis (when an involuntary movement occurs during a voluntary movement). Fortunately, both complications can be improved through appropriate rehabilitative treatment such as neuromuscular facial retraining exercises or, in some cases, infiltration with botulinum toxin. ...

Fibroscopy

What is a fibroscopy? Fibroscopy is an endoscopic examination used especially in otorhinolaryngology. A flexible fibre-optic instrument connected to a cold light source, a camera and a monitor are used to directly examine the cavities of the body. What does a fibroscopy involve? Fibroscopy involves introducing a camera with a light source into the cavities to be examined and is used especially for the respiratory tract (nose and mucous membranes, and throat). With the fibrescope connected to a camera, the specialist will be able to illuminate, examine and see the inside of the nose, pharynx and larynx in order to make a more precise diagnosis. Why is fibroscopy performed? In otorhinolaryngology, fibroscopy is used to examine the nose, rhinopharynx, nasopharynx, hypopharynx, and larynx. This allows for a more accurate diagnosis. The technique has a specific name depending on the area to be examined. Thus, a nasal examination with fibroscopy is called nasofibroscopy; examination of the larynx, fibrolaryngoscopy; and examination of the entire upper airway is called nasofibrolaryngoscopy. Specifically, it is used for people with throat, nose or ear problems. Fibroscopy is frequently performed for the diagnosis of sinusitis, stuffy nose, sleep apnoea, tumours, nasal polyps, deviated nasal septum, dysphonia, nodules, polyps, vocal cord cysts or tumours, and gastroesophageal reflux. Less common applications include examination of the glottis and trachea and the main bronchi in people with a tracheostomy cannula. Preparing for a fibroscopy: In principle, no special preparation is necessary before undergoing fibroscopy. If you have a particularly sensitive gag reflex, the specialist will apply some topical anaesthetic spray (though this is not usually necessary). What do you feel during the examination? Fibroscopy causes a small amount of discomfort because the fibre rubs slightly against the nasal or pharyngeal mucosa. In most cases it is tolerated and can be performed without anaesthetic. It does not cause choking and doesn’t usually cause nausea. However, if the area is sensitive or if you have a severe gag reflex, some anaesthetic spray may be required. Meaning of abnormal results: Fibroscopy can be used to diagnose respiratory tract dysfunctions or pathologies. Based on the results, the specialist performing the examination will consider the best treatment. As this examination is highly precise, it allows the specialist to clearly identify any problems with the throat, nose, larynx or pharynx. ...

Glue ear

This condition is caused when the middle ear fills with fluid, usually mucus. It can cause hearing impairment and usually clears up by itself, but may need treatment if it goes on for longer than three months after which grommets can be placed to aid the drainage. It's a common cause of temporary deafness in children, and factors like infection, parents smoking and being formula fed as a baby have been linked to this condition. ...

Halitosis

What is halitosis? Halitosis is a common problem characterised by an unpleasant odour on the patient’s breath. Normally, halitosis is caused by poor oral hygiene, with bacteria breaking down pieces of food trapped in the teeth and releasing foul-smelling gases. Halitosis can affect the patient psychologically, due to the stigma of bad breath, and can lead to problems in their social life. What causes halitosis? In most cases, the causes of bad breath are oral in nature. In some cases, the smell may originate from the nose, sinuses, throat, lungs, oesophagus, or stomach. Some common causes are: Poor oral hygiene – bacteria will build up in the mouth, attracted to pieces of food trapped in the teeth, and will release toxins and gases that cause the unpleasant smell. Gum disease Eating strong-smelling food, such as garlic and onions. Smoking Drinking alcohol Occasionally, certain illnesses or medications can also cause bad breath. Can it be prevented? Halitosis can be prevented with good oral hygiene: Thoroughly brush your teeth and gums twice a day Floss daily Clean your tongue regularly. You should also book periodic check-ups with a dentist to ensure that your teeth and gums are healthy. What is the treatment? In most cases, improving oral hygiene is enough to eliminate bad breath, brushing your teeth and gums, flossing and cleaning your tongue as a daily routine. Cutting down on or avoiding tobacco, alcohol or certain foods and drinks such as coffee may also be recommended. If the halitosis is a consequence of a different pathology, such as gastro-oesophageal reflux disease or a H. pylori infection, you may be referred to a relevant specialist to deal with the cause. ...

Hoarseness

Hoarseness is when the voice becomes raspy and strained, and can be accompanied by a sore throat. It can follow an illness like viral laryngitis or can be caused by overuse of the voice through singing or shouting. If it lasts longer than six weeks it could be chronic and need further investigation. ...

Language disorders

What are language disorders? Language disorders are impairments which affect understanding of what is being said, and the ability to express thoughts and feelings, most commonly seen in children. The disorders can be of three types: Receptive language disorders: represent the inability to understand. Expressive language disorders: hinder the ability to express thoughts and ideas. Mixed disorders: represent the inability to both speak and to understand correctly. What are the symptoms of language disorders? In receptive language, the main symptoms are having trouble understanding what others say, difficulty in following simple instructions, and organising the the information that one hears. These symptoms are difficult to detect at an early age. In the case of expressive language, symptoms can be identified more easily at an early age. Not talking until the age of two, communicating at the age of three but struggling with words, or having difficulty explaining something may be symptoms of expressive language disorders. What are the causes of language disorders? There is no well-defined cause of language disorders, although it is estimated that the main ones may be: Genetics: according to research, between 20 and 40% of children with a history of language disabilities have this disorder. Other conditions: Down’s syndrome, disorders on the autism spectrum, premature birth, learning disabilities. What is the treatment for language disorders? Language disorders should be treated as early as is possible. The main techniques used are: Regular speech therapy: a therapist works with your child on the development of vocabulary and grammar, as well as giving tips on how to help your child at home. Psychotherapy: used when a child has emotional problems due to language difficulties. How can I help my child if they have a language disorder? Talk and communicate with your child as much as you can. If you’re going on a walk, talk to them about what you can see around you, and interact with them. Engage with your child and give them time to respond – don’t feel like you have to fill the silence. Listen to songs, or sing to your child. Read to your child and interact with them while you are reading. Talk to them about the pictures they can see in the book and what they think, for example, the ending might be. ...

Mastoiditis

What is mastoiditis? Mastoiditis is an infection of the mastoid bone, a portion of the temporal bone of the skull located behind the ear. The mastoid bone is full of tine air-filled spaces called mastoid cells. Mastoiditis occurs if the mastoid cells become infected or inflamed, often following a persistent middle ear infection (otitis media). The condition can be either acute or chronic. The infection is more common in children. What are the symptoms of mastoiditis? The symptoms of mastoiditis include: Redness and swelling behind the ear or of the ear lobe Tenderness/pain of the mastoid bone Fever Tiredness and irritability Discharge from the ear Headache Hearing loss in the affected ear The symptoms are often similar to those of otitis media, along with swelling behind the ear. Complications of mastoiditis can include nausea, vomiting, brain abscesses and facial paralysis. How is mastoiditis diagnosed? Your doctor will examine your ear with an otoscope to see if there’s any oedema or irritation. If your GP suspects mastoiditis, they may refer you to an ENT specialist, who may order further tests, such as: Complete blood count (CBC), to see where your leukocyte level stands Ear culture Computed tomography (CT) scan X-rays What causes mastoiditis? Middle ear infections are the main cause of mastoiditis. When the infection spreads to the back of the ear and to the temporal bone, honeycomb structure of the mastoid bone can become infected and inflamed. The most common bacteria causing this infection are pneumococcus, pseudomonas aeruginosa, haemophilus influenzae and group A streptococcus (GAS). Other diseases which may lead to mastoiditis are meningitis, sinus thrombosis, cerebral abscess and facial nerve palsy. Cholesteatoma, an abnormal build-up of skin cells inside the ear which can prevent proper drainage, is another possible cause. How can mastoiditis be prevented? The most effective way of preventing mastoiditis is to timely identify and treat infections of the ears. How is mastoiditis treated? You will have to start taking antibiotics to fight the bacteria causing this infection. To reduce the symptoms, you can take NSAIDs or painkillers. Antipyretic treatment can help you with the symptoms of fever. If the disease isn’t going away with any of these treatment, you may have to undergo a small surgery to drain away any potential abscess there may be in the affected area. Which doctor should I talk to? You should see an ear, nose and throat (ENT) specialist to treat mastoiditis. After doing some tests in order to formulate an accurate diagnosis, the doctor will identify the cause of the infection and suggest the best treatment for you. ...

Ménière's disease

What is it? Ménière's disease (MD is a disease which affect the ears (usually, one at a time) and causes: a sudden ringing noise inside the ear (tinnitus) a roaring or buzzing inside the ear a feeling of fullness in the ear The condition may also lead to sudden attacks of nausea, vomiting, vertigo and hearing loss (hypacousia). Attacks can occur in clusters or several times a week, or they may be separated by weeks, months or years. Vertigo attacks may become as severe as to cause loss of balance and falling down. What causes it? Although there are no known causes for this condition, according to some studies Ménière's disease is caused by blood vessels constriction, which in turn may have been caused by previous viral infections, autoimmune reactions, allergies or genetic factors. The condition may appear at any age; however, the most affected age range is between 40 and 60 years old. People suffering from the following conditions have a higher chance of developing the condition: immune system conditions autoimmune diseases viral infections inner ear electrolyte imbalance vascular conditions Finally, you’re more likely to develop Ménière's disease if you have a family history of the condition. How is it diagnosed? The first step for diagnosing Ménière's disease for an ear, nose, and throat specialist to look at your clinical history. The doctor will ask you if the symptoms last more than 20 minutes per attack, and if you suffer from any hearing loss. You may also have some tests, including: electrocochleography – a record of the electrical response of the ear to sound to check if hearing loss originates from the inner ear or from the acoustic nerve nystamgus – this involves filling the ear with water or air to check if there are any issues with your balancing apparatus To rule out the possibility of a tumour, which in its acute phase may cause symptoms much alike to those of Ménière's disease, you should also have a CT scan and a MRI scan. How can Ménière's disease be treated? As of today, there is no cure for Ménière's disease, but medication can help you control some of the symptoms. A combination of psychiatric medications and H1-antihistamines, which fight the symptoms of vertigo, is the most common treatment. In most complex cases, you may also start taking antiemetics drugs, which can help with the vomiting, as well as anti-inflammatory drugs and immunosuppressive agents. Some changes in your lifestyle can help you fight this condition: eating a low-salt diet (aimed at reducing water retention and thus the fluid build-up within the ear), stopping smoking avoiding alcohol cutting down on chocolate and caffeine Psychotherapy can help you deal with vertigo attacks better and to improve your quality of life. Finally, if these treatments are not effective, the doctor may recommend ear surgery. ...

Middle ear surgery

What is middle ear surgery? Middle ear surgery is a series of surgical interventions to treat problems in the tympanic membrane, in the chain of tiny interconnected bones (the hammer, anvil and stirrup) and in the mastoid cells (cavities of the temporal bone). There are two major surgical procedures: tympanoplasty and mastoidectomy. Tympanoplasty involves ossiculoplasty (repairing the bones) and myringoplasty (closing a hole in the eardrum). Why is middle ear surgery performed? These interventions are recommended for treating middle ear problems. Tympanoplasty is recommended for large eardrum perforations or middle ear infections such as acute or chronic otitis media that cannot be cured with antibiotics. Mastoidectomy is an operation to remove the flat air cavities of the skull behind the ear (temporal bone) in order to treat infections of the mastoid portion in that part of the skull, to treat complications of otitis media, abnormal bone growth, cholesteatoma (skin cell cyst in the middle ear), or to place cochlear implants. What does middle ear surgery involve? The middle ear is accessed through a cut behind the ear or through the ear canal so that the appropriate procedures can be performed, depending on the injury presented by the person. The procedure may involve removing any infection or dead tissue in the eardrum, placing a graft to reconstruct the tympanic membrane, or placing a prosthesis to replace a damaged bone. Preparing for middle ear surgery: Before the operation, the otorhinolaryngologist will check to make sure you don’t have an ear infection. This will require several tests, including an ear examination and a hearing test. In some cases, a CT scan of the head may also be needed. You must also consult your doctor about medication you can or cannot take. For example, you may need to stop taking certain drugs such as aspirin, anti-inflammatories or blood thinners a week prior to surgery. Post-surgery care: To ensure proper recovery after middle ear surgery, you should avoid: Sneezing too hard, or holding in a sneeze Being hit by a jet of water, so you should ask the specialist how to shower and wash your hair Flying Swimming or diving Lifting weights and excess tension You will have to wait a few weeks after the operation to know whether it has been successful or not. Full recovery will take approximately four weeks if the post-operative care guidelines have been followed according to the specialist’s recommendations. ...

Nasal endoscopy

What is a nasal endoscopy? A nasal endoscopy is a multifunctional exploratory procedure performed at the otorhinolaryngologist’s clinic to examine the nose, neck and larynx. It is carried out using a flexible fibre-optic instrument with a cold light source, a camera and a monitor. This allows for an easy and direct exploration of cavities in the body that are normally difficult to see. What does a nasal endoscopy involve? A nasal endoscopy is performed using a flexible fibre optic tube which is inserted through the nose. The procedure lasts approximately three minutes and is performed at the clinic. Local anaesthetic may or may not be used, depending on the case. Why is a nasal endoscopy performed? It is performed to diagnose respiratory tract pathologies or dysfunctions. The procedure allows images and video to be obtained, which is useful for explaining to the person the nature of their pathology. It also allows the specialist to keep a visual record, which helps them evaluate the pathology and its evolution over time, and the effectiveness of the applied treatments. Preparing for a nasal endoscopy: No prior preparation is required. You only need to follow the specialist’s instructions and they will indicate any procedures that need to follow. Only in some cases will local anaesthetic be applied to the nostril through which the fibrescope is inserted (deviation of the nasal septum or a nasal pathology). What does it feel like during a nasal endoscopy? It can be a bit uncomfortable, because a foreign body being inserted into your nose. So, a little anaesthetic may be necessary in some cases. Meaning of abnormal results: This is a quick and effective technique for detecting pathologies or dysfunctions in these structures. Any abnormality can be easily spotted and subsequently treated by the specialist. ...

Nasal polyps

What are nasal polyps? Nasal polyps are semi-transparent growths that can form in any part of the sino-nasal mucosa. These are benign, but they may grow to the extent that they obstruct the nasal cavities. This condition is also called polypoid sinusitis. The polyps can develop at different sites in the cavities, but usually new ones develop further inwards, on the roof and sides of the nasal cavities. Symptoms of nasal polyps Symptoms of nasal polyps vary according to their size. Initially, sense of smell and taste may be muted, which can then be accompanied by partial or complete nasal obstruction. You may also experience a sensation of constant mucus, which does not improve even when you blow your nose. The presence of multiple or very large polyps may cause: A runny nose Snoring A sensation of pressure in the forehead Headache What are the causes of nasal polyps? The causes of nasal polyps are not fully understood, but we know that it has to do with inflammation of the mucous membrane of the nose and sinuses. It is thought that people who develop nasal polyps might have a different immune system response or differences in the chemical build-up of their mucous membrane. There are also suggested links with infection, severe untreated allergies, asthma, and cystic fibrosis. Polyps can develop at any age, though they are more common in young and middle-aged people. Can nasal polyps be prevented? Prevention consists of treating diseases like allergy or asthma and following the required treatments. In addition, it is important to avoid nasal irritations and to practice good hygiene via nasal washes. It may also be helpful to use a humidifier at home to moisturise the nasal cavities. If the problem is an allergy, use of antihistamines, nasal aerosols and/or an anti-allergy vaccination may help to prevent nasal polyps. What is the treatment for nasal polyps? Medical treatment is recommended according to the grade of the polyps. It may consist of a topical corticosteroid, an oral corticosteroid and/or antibiotics if there is sign of infection. If there is no response to treatment, a surgical treatment is recommended; this consists of removal of the nasal polyps and opening of the paranasal sinuses using endoscopic techniques. ...

Nasal trauma

Nasal injuries are injuries to the nose.

Neck lump

How common are neck lumps and are they serious? Neck lumps are extremely common and in the vast majority of cases are benign. They can be found anywhere on the next and may be soft or hard, asymptomatic or painful and tender to the touch. Neck lumps have many possible causes, so a diagnosis will be made on both the features of the neck lump itself and any associated symptoms. What symptoms can be associated with neck lumps? Neck lumps can often appear on their own with no symptoms. Most commonly, neck lumps are the result of a swollen lymph node. Lymph nodes are found all over your neck and are part of your immune system. They often swell when you are fighting off a disease or infection, so in most cases a neck lump will occur at the same as other symptoms of the illness you have, and disappear again once you have recovered. You won’t generally need to see a doctor to treat the lump. However, you should seek medical help as soon as you can if you notice the following symptoms: persistently feeling tired losing weight involuntarily difficulty swallowing breathlessness night sweats a hoarse voice which has lasted for more than three weeks How does a doctor diagnose a neck lump? You doctor will start by asking how long you have had the neck lump for and how quickly it appeared. They will ask specifically about the symptoms listed above. Next the doctor will examine your neck to check its size, how soft or hard it is, and whether any other lumps can be detected. Depending on what the doctor suspects is causing your condition, they might examine your ears, lungs, or throat. You might then be referred for tests, such as blood tests or imaging to see the tissues in your neck. What can cause a neck lump? As already mentioned, the main cause of neck lumps is a swelling in a lymph node in response to illness, from the common cold and ear infections to chickenpox, herpes, and HIV. Other causes of neck lumps include: Skin problems – abscesses, skin tags, an even acne can cause lumps in your neck. A skin rash can even affect the lymph nodes underneath the skin, causing them to swell. Salivary gland problems – tubes which carry saliva to your mouth can become blocked by salivary gland stones, causing the tube to swell up. Some conditions such as mumps can cause infection in the salivary gland and swelling. Thyroid disorders – the thyroid gland is situated in your neck and can sometimes develop nodules or tumours. In the majority of cases these are benign, but in some cases can be a sign of thyroid cancer Lipomas – this is a benign tumour made of fat that grows under the skin. Lipomas can be found in the neck but are most often found in the back Cancer – in rare cases, swollen lymph nodes can be a sign of blood cancer, and lumps on the skin may be caused by skin cancer. Treatment of neck lumps depends on the cause. For example, thyroid problems can often be tackled with hormone treatment, whereas skin tumours or lipomas are likely to require surgery. You will be referred to the appropriate specialist as part of the diagnostic process. ...

Nose

The nose is the part of our face which sticks out above the mouth, and through which we breathe and smell. The nose houses the nostrils, which help us to take in and expel air as part of the respiratory system (along with the mouth). Our nose plays an important role in our overall health, as it filters the air that we breathe and removes dust and irritants. It contains nerve cells which help our sense of smell, and also helps warm the air coming in through it in order to keep the lungs and throat from drying out. Therefore, if there is a problem with our nose, our health can be affected. Problems affecting the nose There are many conditions and medical problems which can affect the nose, including: Sinus infections: when cavities around the nasal passage are inflamed or swollen Allergies: certain allergies, such as a pollen allergy, can result in nasal congestion, sneezing, postnasal drip, and sinus headaches, among other nasal problems. Smell disorders: disorders include hyposmia, a partial loss of smell, and anosmia, a complete loss of smell, among others, which can occur as a result of an underlying condition or because of an illness. Nasal congestion: when the nasal passages become blocked, often as a result of the membranes in the nose swelling from inflamed blood vessels. Deviated septum: the septum is the part in the nose which divides the nasal cavity in half. When the septum is off-centre or crooked, this can make breathing difficult. It is estimated that 80% of people have some kind of misalignment of the septum, but this does not mean their breathing is affected in every case. Only deviation to the point where breathing is difficult or where serious problems are created requires treatment. Nasal fractures: more often referred to as a broken nose, fractures of the bones in the nose are relatively common, and can occur as a result of trauma (e.g falls, assault, collision). Nasal fractures can cause bleeding, swelling in the nose, bruising, and problems with breathing through the nose. Colds and sneezes: one of the most common problems affecting the nose is the common cold, which is a viral infection affecting the ears, nose, and throat. Who treats problems with the nose? Ear, nose and throat problems, if passed to a specialist, are typically treated by an otolaryngologist, more commonly known in the UK as an ENT doctor (ear, nose and throat). However, it depends on the pathology affecting the patient, as allergic problems may also be treated by a specialist allergist. Cosmetic procedures affecting the nose such as rhinoplasty may be performed by a plastic surgeon, though it is advisable to visit a specialist facial plastic surgeon (often an ENT doctor, but sometimes an oral and maxillofacial specialist) as they have a thorough knowledge of the nose, its anatomy, and the conditions affecting it. ENT surgeons can also correct problems with the nose which are non-cosmetic and related to breathing/respiratory difficulties, such as a deviated septum. ...

Nystagmus

What is nystagmus? Nystagmus is an ophthalmological condition characterised by an involuntary, repetitive movement of the eyes. The velocity of the movement varies, from fast to slow, and generally both eyes are affected. Nystagmus can be classified into different groups: Neurological nystagmus is related to the central nervous system; it can occur after different diseases, such as a brain tumour or multiple sclerosis. Idiopathic nystagmus appears in childhood, normally in the first 6 months of life. The cause is a congenital defect in the part of the nervous system responsible for stabilising the gaze. Sensory nystagmus is caused by a profound visual deficit during the earliest stages of growth. It is frequently due to congenital cataracts or early retinal diseases. Symptoms of nystagmus The most visible symptom is involuntary movement of the eyeball. However, the primary symptom is poor vision, especially with idiopathic nystagmus, given that it is more difficult to fix the gaze on the object correctly and to project a clear image onto the retina. As a result, the eye does not develop as it should. Oscillopsia is a condition that may occur with acquired nystagmus; it is the sensation that your surroundings are moving about. In some cases, there is a gaze position in which the movement is minimal or almost disappears. This is called the neutral zone and it may lead to torticollis, as a result of the patient moving their head and eyes to achieve this neutral zone. Torticollis refers to an abnormal, asymmetrical head or neck position. What are the causes of nystagmus? The cause may be congenital, either due to a genetic condition or congenital eye disease. Other causes include ingestion of certain medications, hereditary factors, trauma, inner ear problems, drug or alcohol abuse etc. Can it be prevented? This condition cannot be prevented. However, it is important to control alcohol consumption. It is also important to undergo annual ophthalmological evaluations. What is the treatment? The treatment depends on the type of nystagmus, given that each type has a range of potential causes. Treatment may consist of certain medications to reduce the movement or the use of botulinum toxin for its “paralysis” action; however both types of treatment can sometimes be associated with side-effects. In cases of torticollis, glasses with prisms or surgery of the muscles can help to improve the position of the head, as they shift the neutral zone to somewhere in front. In addition, it may reduce the intensity of nystagmus. ...

Orbital cellulitis

What is orbital cellulitis? Orbital cellulitis is an acute infection of the tissues surrounding the eyes, specifically the eyelids and eyebrows that can spread to the cheeks. What are the symptoms of orbital cellulitis? Symptoms can include: Painful inflammation of the upper and lower eyelid and possibly of the cheek and eyebrow Decreased vision Bulging eyes Fever, usually 38.9°C or higher Eye pain, especially when moving the eye A general feeling of discomfort Bright red or purple eyelid Difficult or painful eye movements How is orbital cellulitis diagnosed? Your doctor will diagnose the condition with a simple physical exam and take a look at your medical history. If eye pain and vision problems are present, your doctor may perform a blood test. Sometimes a CT scan or MRI scan will be used to get a clearer picture of the eye and the inflammation. What are the causes of orbital cellulitis? This condition is usually the result of a sinus infection which spreads to the eyes, eyelids and areas surrounding the eyes, like the brows and cheeks. Bacterial infection, that might occur after an injury or an insect bite can also lead to orbital cellulitis. Children are more likely to be infected in comparison to adults. The bacteria that most commonly causes orbital cellulitis are: Haemophilus influenza Staphylococcus Streptococcus Can orbital cellulitis be prevented? Hib (Haemophilus influenza type B) vaccines can prevent Haemophilus influenza type B infection in children and prevent this from causing orbital cellulitis. It is also possible that children who share a family group with someone who has this infection have to take antibiotics to avoid becoming infected. On the other hand, adequate treatment of a sinus infection or a dental infection can prevent bacteria from spreading to the eyes and causing cellulitis of the eyelids and tissues around the eyes. What is the treatment for orbital cellulitis? It is essential to treat orbital cellulitis adequately so that it does not cause damage that can persist into adulthood. Most cases will require hospitalization. Antibiotics will be given intravenously through a vein in the arm. Surgery may also be needed to drain the abscess or relieve pressure around the eyes. Orbital cellulitis should be treated rapidly to avoid complications or loss of vision. ...

Otitis

What is otitis? Otitis is also known as an ear infection and occurs when there is a bacterial or viral infection within the ear. Ear infections can be acute, lasting a short duration, or chronic with frequent occurrence. Otitis can affect the internal or external parts of the ear. Ear infections are common in children. These are the different types of otitis: Otitis externa – also known as a swimmer's ear, it affects the external ear, specifically the ear canal. Otitis media – also known as a middle ear infection, with inflammation forming behind the eardrum. Acute otitis media – usually painful, but occurs suddenly and lasts a brief period. Chronic ear infection – when the infection does not disappear or it keeps recurring. Otitis media with effusion (OME) – following an infection, mucous or fluid continues to build-up in the middle ear, making the ear feel “full”, affecting hearing. What are the symptoms of otitis? The most frequent symptoms of otitis are: Earache Fever Irritability Difficulty sleeping Vertigo (loss of balance) Nausea and/or vomiting Diarrhoea Yellow, clear discharge from the ears Loss of appetite What causes otitis? Common causes of otitis are: If the Eustachian tube becomes blocked or swollen, causing fluid to build-up Infection of the upper respiratory tract that spreads to the ears Allergies (allergic otitis) Sinus infections Exposure to moisture causes Swimmer’s ear Changes in air pressure Adenoid infection Can otitis be prevented? There are a few preventative measures that can be taken to avoid ear infections, including: Towel drying your ears after bathing When swimming use a swimming cap and earplugs Prevent any foreign objects entering your ears (e.g. cotton buds) Wash your and your child’s hands often Ensure your child’s vaccines are up-to-date Avoid smoky environments Feed your child upright, rather than on their back What is the treatment for otitis? Mild ear infections will usually go away without intervention, and relieving symptoms with painkillers and warm cloths to the ear will suffice. If the infection is more severe, antibiotic medicine or eardrops can be prescribed. ...

Otology

What is otology? Otology is the branch of medicine concerned with the study of the ear and its diseases. This discipline is part of otorhinolaryngology, the speciality concerned with the prevention, diagnosis and treatment of diseases of the ear, nose and throat. Unlike otorhinolaryngologists (also known as Ear, Nose and Throat [ENT] specialists), otologists do not treat diseases of the nose and neck. Otologists are specialised in the physiology, function and diseases of the ear. Otology is a branch of medicine and surgery; as such otologists are also qualified to perform surgical interventions. Which diseases does otology treat? Otology is dedicated to treating ear problems, so not only hearing problems but also balance problems. The ear plays a fundamental role in balance and the sensation of vertigo and dizziness. Some of the most common pathologies in the otology clinic are the following: Otitis or ear infection: very frequent, especially in babies and children. Tinnitus: annoying perception of continuous sound or ringing, which sometimes prevents the patient from hearing clearly. Barotrauma: a lesion caused by changes in barometric (air) or water pressure. Menière’s disease: a common cause of vertigo and dizziness, due to liquid problems in the middle ear. It also usually causes tinnitus. What are the subspecialties within otology? Otology is focused on the study of the ear and is a subspecialty of otorhinolaryngology. Professionals may further specialise in a specific disease or a specific part of the ear (external, middle or internal ear), for example, damage to the eardrum or middle ear surgery. When would I have to visit the otologist? You may need to visit the otologist if you experience changes in hearing, or pain or discomfort in your ears, or dizziness or vertigo. ...

Otomycosis

What otomycosis? Otomycosis is a fungal infection of the outer ear. There are many types of fungus that can cause an ear infection, the most common being Aspergillus and Candida. Because fungi require warmth and moisture to grow, otomycosis is most commonly seen in hot and humid climates, particularly during the summer. It is also more common among people who play water sports or go diving. Finally, you are more vulnerable to otomycosis if you have a weakened immune system, eczema, or you have had injury or surgery to the ear. What’s the prognosis? Generally, the infection will respond well to treatment. It can take longer to recover if you use a cotton bud to “clean out” the ear. Unfortunately, the infection is likely to recur if you return to the environmental conditions that cause it – such as going straight back to water sports. You’re also more likely to have further infections if your body’s ability to fight off infections is weakened. This can be the case if you have a condition such as diabetes or AIDs. Symptoms of otomycosis Common symptoms of otomycosis include: pain around the outer ear redness and itching swelling hearing problems discharge from the ears – this could be white, yellow, green or black How is otomycosis diagnosed? If you go to the GP with the symptoms above, they are likely to suspect a bacterial infection and will initially give you antibiotics as a first line of treatment. Antibiotics are ineffective against a fungal infection, so if you have recently practised water sports in a tropical climate and you suspect it could be fungal, it’s important to let your doctor know about this. To diagnose otomycosis, the doctor can take a swab of your ear and have this tested in the laboratory for any fungi or bacteria. Can otomycosis be prevented? The main steps you can take to prevent otomycosis are: try to prevent water getting in your ears when swimming or surfing. Special swimming caps or ear plugs are available to purchase online or in sports shops. try to avoid swimming in contaminated water. dry your ears thoroughly after swimming and after showering avoid using ear buds in your ears How is otomycosis treated? At first, the doctor is likely to clean your ear first using swabs and a syringe. This may need to be carried out several times. You’ll then be prescribed antifungal ear drops to take regularly. You’ll be told how quickly to expect results and when to come back if you don’t notice any improvement. Finally, you will receive some advice on what to do yourself to help the infection improve, including activites to avoid. ...

Otoneurology

What is otoneurology? Otoneurology or neuro-otology, as its names suggest, combine aspects of otology (the field of medicine studying the ear and its conditions) and neurology (which deals with the brain and nervous system). Neuro-otology is a sub-specialty in the field of ear, nose and throat (ENT) dealing with conditions of the ear and how they’re related to the central nervous system, as well as how conditions of the inner ear can result in a balance disorder. This field deals with all the parts of the ear, all the central and peripheral nerves connected to it and about how this overall structure is connected to the other structures in the body. What diseases are treated by otoneurology? The conditions and disorders treated by neuro-otology are: Ear and temporal bone infections, such as tinnitus, several types of otitis, meningitis, toxic, bacterial and syphilitic labyrinthitis, extradural or brain abscess and Ramsay-Hunt syndrome (RHS) Vascular conditions: labyrinthine infarction, labyrinthine ischemia, labyrinthine haemorrhage and Wallenberg syndrome Inner ear autoimmune conditions Otosclerosis Traumas: labyrinthine concussion, trauma-induced hearing loss Multiple sclerosis Lower jaw and cranial disorders Vestibular function (balance) rehabilitation Severe cases of vertigo, such as paroxysmal positional vertigo or migraine-related vertigo Ménière's disease Tumours of the temporal bone, of the posterior cranial fossa, of the middle ear and meningioma Certain skull base conditions During an examination, the doctor will look at your posture and how you walk. Afterwards your inner ear and cranial nerves function will be checked with several different tests and stimuli. Some of the techniques used in an examination may be: Romberg’s test Finger-nose coordination test Frenzel goggles Stimuli with hot and cold water When do I need to see a neuro-otologist? You may need to consult a neuro-otologist if you are experiencing symptoms that indicate you might have an otoneurological problem, such as hearing loss, facial paralysis, and balance problems. A neuro-otologist can perform the surgery you may need if the tests and examinations identified a neuro-otological condition. ...

Otoplasty

What is otoplasty? Otoplasty, which is also known as ear correction surgery or cosmetic ear surgery, is a surgical procedure to change the size, shape or position of the ears. Otoplasty is often associated with pinning ears back that appear as very protruding, so this is a common form of otoplasty carried out, but it is also known as pinnaplasty. Depending on the age of the patient, the intervention can be performed under general or local anaesthesia. Otoplasty can be carried out on children, but after the age of 5 years is recommended, as any younger and the ears will still be growing and developing. It is important to understand that otoplasty does not alter or affect your hearing, just the appearance of your ears. Why is otoplasty done? Otoplasty will be considered if your ears stick out a lot, if they appear as very large in proportion to your head, if you need to correct previous ear surgery, or if your ears have been damaged due to injury or congenital malformations. What does otoplasty consist of? Otoplasty can usually be carried out with local anaesthetic and is performed by either an otolaryngologist (ENT surgeon) or a plastic surgeon. A small incision is made behind the ear to gain access to the ear cartilage. Next, small sections of cartilage and skin are removed, depending on what results are being aimed for. Once done, the ear is positioned into place using scoring and stitching techniques. The whole procedure takes up to two hours. Newer techniques use special clips placed under the skin to reshape and reposition the ears. Preparation for otoplasty: Once you have been deemed healthy and suitable for surgery, your surgeon will advise you on any fasting required, which medications have to be stopped and any other requirements for having otoplasty. You will not be able to drive home after surgery, so making alternative arrangements beforehand will be necessary. Aftercare: Otoplasty is often carried out as a day-case procedure, meaning the patient can return home on the same day. You will have bandages around your ears after the procedure for protection. You may experience some itching and discomfort, but painkillers can manage this. It is important to avoid putting pressure on your ears, so try not to sleep on your side or rubbing your ears. Wearing loose-fitting collars is also advised for comfort. Bandages should be worn during the day for the first few days, and afterwards just when sleeping for a couple of weeks. You should avoid swimming and other sports for several weeks to protect your ears. Stitches can be removed after 5-10 days, children can usually return to school after 1-2 weeks. Return to normal activities, such as swimming and contact sports can resume after 12 weeks. ...

Otosclerosis

What is otosclerosis? Otosclerosis is the abnormal growth of bone in the middle ear, which usually causes hearing loss. What are the symptoms? The main symptoms of otosclerosis are: Hearing loss: mild at first and progresses slowly but gets worse over time. Tinnitus or ringing in the ears. Vertigo and dizziness. What are the causes of otosclerosis? The symptoms of otosclerosis are produced by the abnormal growth of a spongy bone in the middle ear. This prevents the bones of the middle ear from vibrating to the sound waves and therefore makes hearing impossible. The cause of otosclerosis itself is unknown, although there is a hereditary factor involved. Is otosclerosis preventable? It is not possible to prevent otosclerosis and so its early detection is essential in order to provide the necessary treatment and avoid hearing loss. Treatment of otosclerosis It is very important to have regular check-ups with your otolaryngologist (ENT) specialist to control bone growth and prevent hearing loss. Untreated otosclerosis will get worse and affect hearing. To treat the problem a stapedectomy or stapedotomy surgery is performed in which the bones of the middle ear (abutment) are replaced in whole or in part by prosthesis. ...

Parotid gland

There are three major salivary glands that generate and empty saliva into the mouth: the submandibular gland, sublingual salivary glands and the parotid glands. Surgery of the parotid gland, also known as parotidectomy, is the operation to remove tumours that grow in the gland. It is estimated that over 70% of these tumours are benign (noncancerous) but all instances should be investigated. The type of operation performed depends on the type of tumour , its size and its location. The most common are superficial parotidectomy or total parotidectomy, with conservation of the facial nerve, which also involves a lymph node dissection. The salivary glands may also develop other diseases. The most common are sialolithiasis, which is blockage and inflammation of the salivary glands by calcium stones that do not allow the output of saliva; and sialadenitis which can be an effect of sialolithiasis, or be caused by a virus or bacteria. ...

Pharyngitis

What is pharyngitis? Pharyngitis, or a sore throat, is the inflammation of the pharynx, which is located between the tonsils and the larynx, at the back of the mouth. It is characterised by a scratchy feeling and difficulty swallowing. Pharyngitis usually subsides within a week and is caused by a viral or bacterial infection. It causes a sore throat, fever, a rash, redness of the pharynx, swollen lymph nodes, a headache and difficulty swallowing. Most cases tend to occur during the colder months. The condition is contagious and often spreads among family members and close contacts. What are the symptoms of pharyngitis? A sore throat is the main symptom of pharyngitis. Other symptoms include: A runny nose Fever A headache A cough Fatigue Muscle aches and joint pain Chills Swollen lymph nodes A rash Loss of appetite General malaise What causes pharyngitis? Pharyngitis is caused either a virus or bacteria, such as: The common cold Influenza Mononucleosis Strep throat (caused by group A streptococcus) The following are risk factors for developing pharyngitis: Exposure to colds and the flu (e.g. people with jobs in healthcare) Allergies Sinus infections Exposure to smoking Smoking Can pharyngitis be prevented? To prevent pharyngitis, you should avoid contact with those already infected. Some measures include: Avoid contact with sick individuals Avoid smoking Wash your hands often Don’t share food or drinks with people How is pharyngitis treated? If the cause of the pharyngitis is viral, then home care is the main treatment. It is important to stay hydrated, eat well, gargle with warm, salty water and get lots of rest. Throat lozenges and over-the-counter painkillers can also help relieve any pain or discomfort. If it is caused by a bacterial infection, antibiotics can be prescribed, commonly amoxicillin and penicillin. ...

Phonosurgery

Phonosurgery is undertaken to restore, change or improve the voice. It can be in the form of injections, microsurgery or open surgery. The reasons may be due to disease damage, misuse of the voice, or part of the gender reassignment process. ...

Pinnaplasty

Pinnaplasty is plastic surgery to correct prominence or asymmetry of the ears. It is an outpatient procedure and takes about an hour.

Polysomnography

What is polysomnography? Polysomnography is a non-invasive and painless test that allows the study of sleep, its phases (REM and non-REM sleep cycles) and its various alterations. It is also known as a sleep study. When you fall asleep, you begin with non-REM sleep, in which an EEG will record much slower brain waves. Eventually, usually after a couple of hours of non-REM sleep, brain activity increases and you will enter REM sleep. This is when your eyes move back and forth and when most dreaming occurs. This cycle happens, on average, six times per night, which if disrupted can result in sleep disorders. What does polysomnography consist of? When having a sleep study, you will be given a room not dissimilar to a hotel room and asked to prepare for bed. Sensors will be stuck to your head, scalp and chest which are connected to a computer. A finger-clip measures oxygen levels in your blood. Whilst asleep, the following are monitored: Blood pressure Blood oxygen levels Breathing pattern Brainwaves Eye movements Heart rate Limb movements Snoring or other noises made during sleep Time taken to fall asleep Duration of each sleep cycle A specialist observes from another room. The sleep period is also recorded on video for further analysis. If you are being tested for sleep apnoea, you may be connected to a PAP (positive airway pressure) machine that consists of a nose-piece to provide additional air and oxygen during sleep. Why is polysomnography done? This test is used to diagnose possible sleep disorders, such as obstructive sleep apnoea, insomnia, narcolepsy, excessive sleepiness, restless legs syndrome or night terrors, among others. Hence, polysomnography can indicate when your sleep pattern is disrupted and why. Preparation for polysomnography: Unless otherwise instructed by the doctor, the patient should not take any medication to sleep or consume alcohol or caffeinated beverages before the exam as they may disturb sleep. How does it feel during polysomnography? In general, polysomnography is performed at night, in specialised centres while the patient sleeps. Electrodes are placed on the chin, scalp and outer edge of the eyelids. Meaning of abnormal results: Polysomnography records how often the person stops breathing for at least 10 seconds and how often the breathing is partially blocked for 10 seconds. In addition, it also records brain waves and muscle movements during sleep. Abnormal results may mean that the patient has sleep apnoea. To make the correct diagnosis and establish the treatment, the specialist must examine other results of the polysomnography, the patient's clinical history and perform a physical examination. Therefore, a follow-up appointment will be needed to discuss the results. ...

Posturography

What is posturography? Posturography is a test that measures and assesses a patient's balance function using a computerised platform. It can be carried out in-clinic and usually takes around 20 minutes. What does posturography consist of? Posturography involves placing the patient on a platform and measuring their movements. The platform may be static, or it may be dynamic, able to move in response to the patient or carry out a set of standard movements to test the patient’s balance in different situations. The data obtained produces detailed images and reports, comparing the patient’s responses with what is normally expected for a patient of their age and body shape. Two of the key measurements made are the patient’s centre of gravity (COG) and their centre of pressure (COP). Why is posturography performed? A posturography is carried out for two types of patients: hose who have symptoms of vertigo or imbalance but have not been diagnosed clearly with physical and clinical examination those who have a known cause but need to know how the problem affects their daily life What does the exam feel like? The patient stands in an upright position on the platform, with the heels together and the tips slightly apart, forming an angle of about 30 degrees, and with the arms extended. It is important that the patient is relaxed and remains completely silent, since there should be no stimulus that can alter the balance. The specialist will ask the patient to make different movements to register them. Meaning of abnormal results of posturography This test diagnoses balance problems, whether of nervous, visual or sensory origin. The main diseases associated with imbalance are: vertigo labyrinthitis (infection and/or inflammation of the inner ear) vestibular neuritis (infection of the vestibular nerve of the inner ear) perilymph fistula (leakage of fluid from the inner ear to the central ear) Meniere's disease Parkinson’s disease arthritis visual disability back or neck pain ...

Radiofrequency treatment

What is radiofrequency treatment? Radiofrequency is a minimally invasive procedure which can be used to treat varicose veins. It is performed under local anaesthetic, and uses the application of heat to damage tissue, meaning scar tissue forms. This closes the varicose vein and cuts it off, meaning it is destroyed. This type of treatment can be used on large varicose veins.ç Why undergo radiofrequency treatment? Varicose veins can be considered unsightly by some, and many wish to have them removed. Varicose veins can also be painful and cause discomfort. Several types of procedure are available for the treatment of varicose veins, and different ones will be indicated depending on the patient and the size of the vein. As radiofrequency is able to destroy larger veins, it may be indicated in patients who have veins of significant size. What does it involve? The procedure is performed while the patient is awake, as a local anaesthetic is given to numb the particular area where treatment will be applied. Radiofrequency (an electrical current) is passed through a catheter injected into the vein, which heats up the vein wall and damages it. This causes the vein to close off. Radiofrequency is generally a successful procedure, and the vein closes off in most patients. One advantage of radiofrequency is that it is less painful than traditional varicose vein surgery, which removes the vein itself. Some side effects may include burns on the skin, pain after recovery, or clotting in the vein. However, these risks are minimal and usually get better over time. How to prepare for radiofrequency treatment Before the treatment, a medical history will be taken to see if the patient is suitable, and where the procedure should be performed. Medication will also be discussed, and those who take aspirin or blood-thinners (such as ibuprofen) as long-term medication will be told to stop several days before the procedure. Post-operative care After the procedure, the surgeon places a dressing on the area which has been treated. This dressing must be worn for at least 24 hours. After these 24 hours are up, the patient then should wear compression stockings for at least two weeks. Some mild pain may be experienced, which can be relieved using over-the-counter painkillers. A follow-up ultrasound will be taken around a week after the procedure, to check the vein is closed and to see if a deep vein thrombosis has developed. This occurs rarely but it is a possibility and it is important for the surgeon to check. Patients are advised not to partake in strenuous activity for a few weeks afterwards, but light activity is encouraged and the patient will be able to return to work soon after the procedure. ...

Radiofrequency turbinate reduction

What is radiofrequency turbinate reduction? Radiofrequency turbinate reduction surgery involves the application of high-frequency radio waves which cut through nasal tissue in a controlled way, reducing the turbinates to improve air flow. The waves are applied directly to the targeted tissue using cold electrodes. At the start of the procedure, a thin radiofrequency probe is inserted through the nostrils. Why is it done? Radiofrequency nasal surgery is performed to reduce the size of the turbinates and to make breathing better and easier. Turbinates are small structures within the nose that are responsible for cleaning and humidifying the air that passes through the nostrils. If they become inflamed and swollen, either by infection, allergies or irritation, they produce mucous, causing congestion. What does it involve? The procedure is performed under local anaesthesia and usually lasts between 5 to 15 minutes. A needle-like probe is inserted through the nostrils, which then transmits energy to the targeted tissues. The surgery is performed under local anaesthesia and usually lasts between 5 to 15 minutes. The radiofrequency energy helps to reduce the size of the turbinates without harming the nasal mucosa. No scarring is caused by this procedure. How to prepare for radiofrequency turbinate reduction: You should speak with your specialist about which medications you can take before the procedure. You may have to stop taking certain medications, such as anti-inflammatories or anticoagulants. Aftercare: Post-operative care is fast and straightforward; you will have to perform nasal washes with saline, to promote healing and to clean the treated area. Also, in the first few days after the procedure, you should avoid physical exercise, intense heat and aspirin. Nasal scabs will probably form in the first few weeks. ...

Rhinitis

What is rhinitis? Rhinitis is a condition where the nasal mucosa becomes inflamed. The nasal mucosa is the lining of the inside of the nose. This is a common condition and is thought to affect one in every five people in the UK. Rhinitis can be triggered by allergies, which is called allergic rhinitis (e.g. hay fever). Rhinitis can be acute or it can be chronic (long-lasting). What are the symptoms of rhinitis? The main symptoms are sneezing, an itchy nose, itchy eyes, an itchy throat, a lack of smell and a blocked nose with nasal discharge. Due to nasal congestion, the patient cannot breathe freely or easily. The symptoms occur mostly in the morning. This can be confused with a simple cold, but a cold will resolve in around two weeks, whereas rhinitis persists. What causes rhinitis? There are several causes of rhinitis. Rhinitis can be classified into three main groups: Allergic rhinitis – caused by the immune system reacting to an allergen. Often flares up on a seasonal basis. Non-allergic rhinitis – infection (bacterial or viral) causes infectious rhinitis; vasomotor rhinitis is caused by vasoconstrictor medications; hormonal rhinitis is caused by hyperthyroidism or pregnancy; mechanical rhinitis is caused by foreign bodies or a deviated septum. Atrophic rhinitis – caused by the reduction in size of the nasal mucosa. How can rhinitis be prevented and treated? For allergic rhinitis, it is difficult to completely avoid the triggering allergens, however, attempts can be made to reduce exposure, such as avoiding leaving the house early in the morning when pollen is at its worst and keeping the windows closed. Other treatment measures include: Regularly cleaning the nasal passages Antihistamines can help with allergic rhinitis Corticosteroid sprays Immunotherapy Antibiotics Surgery ...

Salivary gland surgery

What is salivary gland surgery? The main salivary glands, those that generate and empty saliva in the mouth, consistent of three pairs: the submandibular glands the sublingual salivary glands the parotid glands. Salivary gland surgery is responsible for removing any of these glands. Anaesthesia during the procedure will depend on the gland that is removed: if it is from major salivary glands, such as the parotid gland, the procedure involves general anaesthesia, whereas if it is of minor salivary glands, local anaesthesia will be used. Why is salivary gland surgery performed? Salivary gland surgery is usually performed to remove tumours that grow in these glands and analyse them. It is estimated that more than 70% of these tumours are benign (non-cancerous), but any lump that is detected must be analysed. The salivary glands can also present other pathologies, including: sialolithiasis – obstruction and inflammation of the salivary glands due to the presence of calcium stones sialadenitis – infection of the salivary glands, which can be an effect of sialolithiasis, or be caused by a virus or bacteria. What happens during salivary gland surgery? There are several surgical techniques depending on the gland that needs intervention: Parotidectomy (removal of the parotid glands) – this can be superficial, which is done when the tumour is on the facial nerve and usually removes the tumor without affecting the nerve, or total, which is carried out when the tumour surrounds or grows towards the facial nerve. In both cases, surgery consists of making a cut in front of the ear and down the neck to access the tumour and remove it. Submandibular sialoadenectomy: this consists in making an incision under the jawline to access the gland and extract it, sometimes along with the surrounding lymph nodes. Surgery of the sublingual glands: an incision is made through the mouth to extract a cyst called ranula. Surgery of the minor salivary glands: consists of making a cut in the area where the gland is located to access it and remove the tumor, the soft tissue and the area of affected bone. In all surgeries, the area is closed with sutures once the affected tissue is removed. In some cases, it may be necessary to put temporary drains to remove fluids, such as saliva or blood. Preparing for salivary gland surgery Before the intervention, the specialist can perform a physical examination and talk about what medications can be taken beforehand and which ones cannot. Post-operative care After the procedure, the specialist observes the facial movements of the patient, asking them to smile or make facial gestures. Once at home, it is important to follow the doctor's instructions about wound care and drainage. The patient may also return to the clinic to remove the sutures. Once removed, the patient has to wash the area with mild soap and water. ...

Septoplasty

What is it? Septoplasty is a corrective surgical procedure done to straighten the nasal septum, eliminating any congenital or trauma-induced deviations. Such deviations represent an obstruction which makes breathing harder. During the procedure, the surgeon may also resect your turbinates (if they are hypertrophic). Sometimes the procedure may involve an aesthetic intervention on your nose, thus becoming a rhynoseptoplasty. What is it for? Your ENT specialist may suggest surgery if you have trouble breathing due to a deviated septum. How does it work? Should there be a severely deviated septum, the surgeon may have to remove the septum completely, straighten it and then insert it back. In other cases, the surgery can be done internally from your nose, passing through the nostrils. During the surgery, the cartilage segments (and sometimes small bone fractions) causing the deviation are removed. How can I prepare for it? First of all, you’ll need to go through your medical history with your doctor. The doctor will also check your general state of health and study the shape of your nose. If you smoke, you’ll need to stop before the procedure. You will also have to avoid taking any non-steroidal anti-inflammatory drugs (NSAIDs) two weeks before and two weeks after the procedure. Post-operative progress After the surgery, you’ll need to go back to the hospital twice (one week apart from each visit) to check on and replace the dressing, to monitor your recovery and to remove any potential adhesions. Spraying a hyaluronic acid mist on your face can help with the scarring and tissues healing. One week after the procedure, the bones and cartilage should be completely healed. After two weeks your nose won't be as swollen and the mucosa will have healed as well. Other treatment options If you have a mild deviation, laser surgery can be a good option. In this case, the deviated septum is straightened with laser septoplasty. This technique can be helpful for straightening the septum without causing you any pain (neither before nor after it), with much less bleeding and an easier healing process. ...

Skin cancer

What is skin cancer? Skin cancer is one of the most commonly occuring types of cancer. There are certain types of skin cancer. There are non-melanoma skin cancers which are a group of cancers that are slow-growing and develop on the upper layers of the skin. Basel cell carcinoma (BCC) is the most common type of skin cancer and start in the cells of the lower epidermis. Squamous cell carcinoma (SCC) accounts for around 20% of skin cancers and starts in the upper layers of the epidermis. Melanoma skin cancer is more serious and can spread to other parts of the body. What are the symptoms of skin cancer? Basal cell carcinoma: smooth and pearly may be firm and red may sometimes bleed or develop a scab never completely heal itchy Squamous cell carcinoma: tender to the touch sometimes bleed can have a hard cap the skin surrounding the mole is raised Melanomas will usually start with a change to normal skin or can develop on a mole already present. You can use the ABCDE mole checklist to help determine if a mole has become a melanoma. A – Assymetrical moles B – Border of a mole is blurred C – Colour of a mole varies D – Diameter of the mole is irregular and larger than 7mm E – Evolving (melanomas will often change over time) What causes skin cancer? Non-melanoma skin cancers are caused by too much exposure to ultraviolet (UV) light, which comes from the sun, as well as tanning beds. There are also a number of risk factors that can increase the chances of non-melanoma developing: family history of skin cancer pale skin that burns easily people with lots of moles and freckles medication of a medical condition that suppresses the immune system previous non-melanoma skin cancer Melanoma is caused by exposure to UV light from the sun or tanning beds. Melanomas are caused by very intense exposure to UV light, such as bad sunburn on holiday. The following risk factors increase your chances of developing melanoma: pale skin blonde or red hair family history of melanoma people with lots of moles and freckles How can skin cancer be prevented? It is possible to reduce your chances of developing skin cancer by reducing exposure to sunlight and avoiding sunburn. You can do this by avoiding tanning beds, covering up outdoors and wearing high SPF sunscreen. You can also avoid the sun during the hottest part of the day. It is also important to check your skin regularly and notice any changes as early diagnosis increased the chances of treatment. What is the treatment for skin cancer? Non-melanoma skin cancer can be treated firstly by surgically removing the cancerous tumour and surrounding skin. Non-melanoma skin cancer can also be removed to using cryotherapy (freezing). They can also be treated with radiotherapy and photodynamic therapy (PDT). Treatment option depends on the size of the skin cancer, the type and the location. Non-melanoma skin cancers are often treated successfully as the risk of the cancer spreading to other parts of the body is much lower than with melanomas. Melanoma skin cancer is treated surgically most of the time, however, treatment depends on the circumstances of your diagnosis. Early detection and treatment can successfully treat melanoma. Advanced melanoma treatment aims to slow down the spread of the cancer and improve the symptoms. Melanoma can return once treated, so regular check-ups are essential. ...

Sleep apnoea

Sleep apnoea is the interruption of breathing that occurs moments after falling asleep, preceded by a period of loud snoring for at least 10 seconds. If this process is repeated 5 times for each hour of sleep it is called Obstructive Sleep Apnoea Syndrome. Obstruction of breathing causes a decrease in oxygen levels in the body that makes it difficult for the person to have a restful sleep and causes tiredness the next morning. In addition, the persistence of this lack of oxygen could lead to pulmonary hypertension and future right-sided heart failure or myocarditis, so it is important to detect it early and perform relevant tests for a safe diagnosis. A sleep study is carried out to establish treatment that includes the change of some lifestyle habits (diet, abstention from alcohol, postural changes) and the prescription of a CPAP machine, which generates air pressure via a nasal mask. This stops respiratory obstruction, preventing snoring and favouring restful sleep. In some cases, surgery may be required if there are any airway scars or when the mask is not effective. ...

Snoring

What is snoring? Snoring and obstructive sleep apnoea are disorders characterised by temporary upper airway occlusion at the pharynx level during sleep. This causes problems with sleep, fatigue and breathing, and other related problems. Symptoms of snoring: As well as snoring, in more severe cases breathing may stop (sleep apnoea) for more than 10 seconds, resulting in episodes of sleep disturbances throughout the night. These episodes cause oxygen deficiency in the brain, which increases the risk of cardiovascular problems, diabetes or stroke. The affected person may also suffer from drowsiness, general tiredness or depression, and may suffer from impaired concentration and professional and personal performance. What causes snoring? The most common causes of snoring and sleep apnoea are obesity, nasal obstruction (polyps, deviated septum), an elongated soft palate, and hypothyroidism, among others. The common denominator in all situations is that there is a permanent or functional narrowing, which can have its origin at various levels of the upper airway. This produces an intense vibration on the walls of the pharynx, which transforms into the sound we perceive as snoring. Can snoring be prevented? It is difficult to prevent snoring but steps can be taken to improve it. For example: Snoring is made worse by sleeping on your back, so avoid sleeping in this position. Dry air may irritate and inflame the nasal mucosa. Placing a humidifier in the room may be helpful. Some foods contain allergens that provoke reactions and may cause a narrowing of the airways. These should be identified in order to check for possible allergies. Avoid alcoholic beverages in the evening, as alcohol relaxes the muscles of the pharynx, causing the air to vibrate as it passes, which then results in snoring. Certain sleep medications worsen snoring and the severity of sleep apnoea. Smoking dries and inflames the mucous membranes and is therefore strongly discouraged. It may be helpful to raise the headboard of your bed or use more than one pillow. Surgery may be an alternative, especially in cases of anatomical anomalies. How can snoring be treated? Treatment can be based on weight loss, changing lifestyle habits, and giving up smoking and drinking. You can also use a nasal mask that provides air pressure controlled by a mechanical device (CPAP), or you can have surgery. Surgery may be helpful for anatomical abnormalities such as a deviated nasal septum or thickening of the uvula and soft palate. Non-invasive surgical techniques performed under local anaesthetic have been used for years now and they offer rapid postoperative recovery. Another non-invasive alternative is a mandibular advancement device. This is a kind of "dental sleeve" that you wear when sleeping. It moves the lower jaw forward of the upper jaw, thus widening the retrolingual area. It helps prevent snoring and sleep apnoea, is simple to use and has an easy adaptation process. ...

Temporal bone microsurgery

What is microsurgery of the temporal bone? Temporal bone microsurgery is the surgical procedure performed on the delicate bones that make up the side of and the base of the skull. The temporal bone consists of four parts: the squamous, mastoid, petrous and tympanic parts. Temporal bone functions include: Protect the encephalon and auditory organs. Provide part of the joint surfaces for the temporomandibular joint. It is part of the temporal region and the temporary fossa. As the temporal bone has the tympanic cavity and the Eustachian tube in it, it is often associated with ear related disorders, such as tinnitus or ringing in the ears, dizziness, and Ménière’s disease. Why is microsurgery necessary in some cases? Temporal bone microsurgery may be carried out due to an ear disorder or if there has been a trauma to the temporal bone. In fact, fractures are the most common injury. If the fracture can’t properly be seen, there are certain signs that doctors look out for: Soft tissue invasion within mastoid cells or in the tympanic cavity and air in unusual places. The ossicular chain can be dislocated or injured due to a luxation or a fracture, which will be analysed by CT scan. Injuries that affect the skull are the most common reason for problems of the temporal bone, especially direct hits, foreign bodies, or penetrating wounds. When there is a temporal bone fracture there has been a trauma, which is why it is often linked to other skull fractures. What does it involve? Temporal bone dissection is a complex procedure for otologists, neuro-otologists, and ear/skull surgeons. It is essential for the surgeon to have surgical skills and knowledge in order to be able to adequately manage diseases that affect this bone. There are different surgical procedures depending on what the issues are. These include: Simple mastoidectomy: removal of the mastoid cells, the air-filled spaces in the skull behind the ear. In most cases, it is a condition caused by an ear infection and that spreads to the surrounding bone in the skull. Posterior tympanostomy: opening the facial recess by mastoidectomy to communicate the middle ear with the mastoid. It is a posterior ear cavity surgery. It enables direct access and treatment of the pathological processes located in said cavities, while also giving access to other cavities such as the epitympanum and the eardrum. How to prepare for microsurgery of the temporal bone Depending on the procedure to be carried out, the specialist will recommend different pre-procedural instructions. A CT scan will be done to get an idea of the depth and type of lesion. Once diagnosed, an otorhinolaryngologist will recommend what steps the patient should take. Post-operative care Certain precautions will be necessary after surgery because the surgical site is sensitive as it includes the skull and other fragile bones such as the ones that make up the auditory structures. The otorhinolaryngologist will recommend the appropriate post-operative care. Alternative treatments Progress is being continually made in finding minimally invasive procedures, and the subspecialty of temporal bone surgery is no exception. It is a very delicate area, with many nerve endings and sensitive structures, meaning that the less invasive surgery is, the better. ...

Tonsillitis

What is tonsillitis? Tonsillitis is an inflammation of the tonsils that are located at the back of the throat. It is very common in children and adolescents, but adults can suffer from tonsillitis too. What are the symptoms of tonsillitis? If you have tonsillitis, your tonsils will be red and swollen. You will also have a combination of the following symptoms: A sore throat A fever (temperature of 38C or over) A headache Fatigue Nausea Difficulty swallowing Earache White pus-filled spots on the tonsils Swollen glands in the neck What causes tonsillitis? Tonsillitis is caused by a viruses or bacterial infection. Streptococcal tonsillitis is the most common cause. The tonsils are vulnerable to infection because they are one of the body’s first lines of defence in the immune system. Can tonsillitis be prevented? Tonsillitis can be prevented by practising good hygiene: Not sharing eating and drinking utensils. Avoiding contact with those infected. Washing hands frequently. How is tonsillitis treated? If your tonsillitis is caused by a virus, then at-home care is the only treatment for recovery. The following can be used to promote a quicker, more comfortable recovery: Throat lozenges Rest Staying hydrated Avoiding caffeine Gargling with salt water Using painkillers to manage discomfort If your tonsillitis is caused by a bacterial infection, then you will be prescribed a course of antibiotics. These must be taken as instructed, and the full course finished. People who suffer from tonsillitis frequently are advised to have the tonsils removed. If an abscess forms between the tonsils (this is called a quinsy), see a doctor, as this may need to be drained. ...

Tracheal stenosis

What is tracheal stenosis? Tracheal stenosis refers to a narrowing of the trachea, more commonly referred to as the windpipe. It occurs as a result of the formation of scar tissue in the trachea, or due a malformation of the cartilage in the trachea. The narrowing, if mild in nature, may not be noticed, but if the narrowing becomes more severe (over 50% of the airway) then complications are likely to occur. What causes tracheal stenosis? Tracheal stenosis has three main causes: Inflammatory bowel disease Placement of a breathing tube (over a prolonged period of time) Collagen vascular disease Other causes include congenital malformations, infections in the trachea, trauma to the trachea, radiotherapy, cancer, and certain inflammatory diseases such as sarcoidosis. Symptoms of tracheal stenosis If stenosis is mild, and is congenital (e.g from birth) then symptoms may not be identifiable or obvious until later in life. They can, however, be similar to those of asthma or bronchitis. You may notice wheezing while inhaling, and in more serious cases, the following symptoms may present: A blue tinge to the lips A high pitched breathing sound Feeling excessively short of breath If the stenosis is caused by injury to the trachea, these symptoms may not present until several weeks after the original trauma. How is tracheal stenosis treated? There are various treatment methods used in the management of tracheal stenosis, but most cases are treated through endoscopy, where a long thin tube with a light and camera on the end is inserted into your trachea so the surgeon can have a good view of the obstruction. In milder stenosis, a stent may be placed, and some of the scarring can be removed through laser treatment. However, in cases of more severe stenosis, a procedure called tracheal resection may be recommended. In this procedure, the part of the trachea affected is removed and tissue is taken from another part of the body (e.g the cheek) to repair the trachea. Which specialist treats tracheal stenosis? Typically, otolaryngologists (ENT doctors), who are specialists in conditions affecting the ear, nose and throat, treat tracheal stenosis. ...

Tracheostomy

What is a tracheostomy? A tracheostomy involves opening up the trachea, or windpipe, through a surgically made hole. A tracheostomy tube or cannula is placed in the opening so the patient can breathe and so that any lung secretions are removed. Why would you do it? It tends to be done due to obstruction at the oropharynx, larynx, or upper part of the trachea. It is also done when there is: Prolonged intubation Aspiration of pulmonary secretions Permanent swallowing deficit Complex head or neck surgeries There are different types of tracheostomy according to the cause, it may be an emergency tracheostomy or an elective tracheostomy. These can be temporary or permanent. What does it involve? A tracheostomy involves making a hole in the trachea to avoid asphyxiation. A 1.5cm wide incision is made in the throat, in front of the trachea, then the trachea is punctured and dilated until a tube can be inserted. This technique may involve some risks (other than those involved with surgery and anaesthesia) such as damage to the thyroid, trachea erosion, puncture of the lung, and scarring of the trachea that causes pain and difficulty breathing. How to prepare for it This procedure is normally performed under general anaesthetic, unless the tracheostomy is performed as an emergency, in which case there may not be time. When performed as an emergency, local anaesthetic is used so that the patient does not feel pain, while when it has been planned, the patient will be given a general anaesthetic. Post-operative care A person with a tracheostomy is advised to take extra care to keep the area clean, and be ready to know how to deal with a partial or total blockage of the cannula. It is recommended that exposure to aerosols or airborne particles be avoided, to prevent them entering the respiratory tract. In temporary tracheostomies, the cannula is removed, but if it is permanent, the hole will remain open. ...

Turbinate hypertrophy

What is turbinate hypertrophy? Turbinate hypertrophy is a condition affecting the respiratory mucosa. The turbinates, also known as nasal conchae, is a part of the nasal fossa. They are six narrow, curled shelves of bone and connective tissue covered by a mucosa that protrude into the breathing passage of the nose. The turbinates ensure that the air passing through the nose is heated up and humidified. Sometimes they can become inflamed and increase in size. This is what happens when you have turbinate hypertrophy. What are the symptoms of turbinate hypertrophy? Turbinate hypertrophy can cause the following symptoms: A sensation of blocked, obstructed nose; Trouble breathing; Headache; Secretion of mucus from the nose into your throat; Sinusitis; Snoring; Dry, tickly cough; Dry mouth; Impaired sense of smell; Bad breath; Itchy nose; Sleep apnoea; Pain at the base of your nose; Sneezing; Nosebleeds (epistaxis); Nasal or metallic sounding voice (rhinolalia); Hearing loss (hypacousia); A muffled sensation in your ears How is turbinate hypertrophy diagnosed? To confirm a diagnosis of turbinates hypertrophy, you’ll need to go through your medical history with your doctor and do the following exams: Rhinofibrolaryngoscopy; Nasal cytology; Rhinomanometry; Allergy testing What causes turbinate hypertrophy? Some risk factors that may lead to turbinate hypertrophy are: Seasonal or perennial allergic rhinitis; Non-allergic or vasomotor rhinitis; A change in temperature or humidity; Taking certain medications or being on hormone therapy; Frequently recurring common cold; Exposure to certain chemicals; Smoking; Emotional stress How is turbinate hypertrophy treated? The treatments largely depend on the individual case. Your doctor may prescribe you a local treatment based on nasal solutions which can reduce the swelling of the turbinates (in case of a mild to moderate hypertrophy). Should this not be enough, you may consider the option of surgery (middle turbinectomy, inferior turbinates mucotomy or submucosal dissection), consisting in the resection of a part of the mucosa and bones of the turbinates, or you can consider one of the new, non-invasive techniques based on laser or radiofrequency. Which doctor should I talk to? For an accurate diagnosis and treatment of turbinate hypertrophy, you should see an ENT specialist. ...

Tympanometry

Tympanometry is a test to evaluate the functioning of the middle ear and the tympanic membrane. The test involves inserting a device into the outer ear to achieve a tight seal. Then the specialist causes a change in air pressure inside the atrial cavity to check the mobility of the eardrum and to see how the ear reacts to sound and pressure changes. During the test, the patient can hear very loud sound and may notice discomfort because of the probe. The results are plotted on a graph called a tympanogram. This technique is used to detect alterations in the middle ear, tympanic perforation, infectious otitis, tumours, bone diseases affecting the middle ear and birth defects, among others. ...

Vestibular testing

What is vestibular testing? Vestibular testing is a series of tests that check the functioning of the vestibular (balance) section of the inner ear. The vestibular system and the eyes work together to maintain balance and to maintain clear vision when the head is moving. This is known as the vestibular-ocular reflex (VOR). People who complain of dizziness will often go through vestibular testing. What does vestibular testing involve? Vestibular tests often use special equipment that monitor the eyes for normal and abnormal movements, whilst the vestibular section of the inner ear is stimulated. There are different types of vestibular tests, including: Electronystagmography (ENG) Electrocochleography (ECOG) Rotation tests Video head impulse testing (VHIT) Vestibular evoked myogenic potential (VEMP) Why is vestibular testing done? Vestibular tests check the functioning of the vestibular section of the inner ear. If these tests can confirm its functioning, then symptoms like dizziness can be attributed to other causes, such as neurological disorders, low blood pressure or psychological problems. However, first ruling out inner ear problems can save time on running other costly, time-consuming tests. Preparation for vestibular testing Patients are advised to wear loose-fitting clothing on the day of testing and to avoid wearing make-up. Up to 48 hours beforehand the following must be avoided: alcohol nausea or dizziness medication sleeping pills cold-flu remedies over-the-counter pain medication What to expect during vestibular testing ENG: This test measures involuntary eye movement (nystagmus) whilst stimulating the subject’s balance. Eye movements are measured using an infrared video system. ECOG: This test measures the response to sounds from the nervous system. An earphone plays sounds in the ear, whilst an electrode measures the response. Rotation tests: Assesses how the eyes and inner ear are working together. Video goggles or electrodes are used to measure eye movements. This is either carried out through auto-head rotation, computerised rotary chair or a screening test. VHIT: Special glasses with a camera monitor eye movements. Small and quick head movements are evaluated (the vestibulo-ocular reflex). VEMP: Checks if particular vestibular organs and nerves are functioning correctly. Responses are measured from muscles in the neck and around the eyes. Adhesive skin electrodes are used. Sounds are played for a few seconds, and the electrodes record the vestibular response. What do abnormal results mean from vestibular testing? If the vestibular system is found to be functioning fine, then other tests will be carried out to determine the cause of the patient’s dizziness. This may be an MRI, blood pressure test or psychological evaluation. ...

Voice disorders

Voice disorders are disorders in sounds that depend on the larynx (vocal cords) and affect the pitch, timbre, intensity or duration. The origin of such changes can be organic, physiological, psychological or environmental. In addition, there are two types of disorders: dysphonia and aphonia. Aphonia is the total loss of voice temporarily or chronic and can be caused by overuse of the vocal cords, respiratory disease, intake of toxic or irritating products, excessive cold or nervous causes. Treatment may include resting the voice, medication, voice therapy or, in severe cases, surgery. Dysphonia is a disorder of voice intensity due to an injury in the organs of phonation (organic) or poor use of the voice (functional). The most common causes of this condition are overly straining your voice (voice hyperfunction), gastroesophageal reflux, smoking, infections such as laryngitis or tuberculosis, neurological disorders of the larynx, tumors, and trauma, among others. The treatment involves learning relaxation techniques and breathing, exercising the shoulder, neck and face muscles, and speech therapy. ...

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Mr Sean Blaney Otolaryngology / ENTCentral London

Mr Sean Blaney

Otolaryngologist in London

MBBS BSc PhD FRCS(ORL-HNS)

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Mr Sean Blaney
Otolaryngology / ENT
Central London

Otolaryngologist in
London